Healthcare Provider Details

I. General information

NPI: 1245407766
Provider Name (Legal Business Name): BAXTER REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W OLD MAIN ST
YELLVILLE AR
72687-8284
US

IV. Provider business mailing address

PO BOX 718
YELLVILLE AR
72687-0718
US

V. Phone/Fax

Practice location:
  • Phone: 870-449-4221
  • Fax: 870-449-6777
Mailing address:
  • Phone: 870-449-4221
  • Fax: 870-449-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HENRY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 870-508-1003