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General NPI Number Information
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NPI Number | 1003877036
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Entity Type | Organization
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Legal Business Name | BALD KNOB HEALTHCARE CENTER, PA
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 2104 HIGHWAY 367 N
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City | BALD KNOB
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State | AR
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Zip | 72010-9443
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Country | US
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Telephone | 501-724-3110
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Fax | 501-724-0140
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Provider Business Mailing Address
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Address Line | PO BOX 1158
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City | BALD KNOB
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State | AR
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Zip | 72010-1158
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Country | US
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Telephone | 501-724-3110
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Fax | 501-724-0140
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Authorized Official
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Title or Position | MEDICAL OFFICE ASSISTANT
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Name | MRS. TINA RENEE HOLDER
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Credential |
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Telephone | 501-724-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | E2849
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License Number State | AR
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