=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073518593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOONEVILLE COMMUNITY HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 03/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 880 W MAIN
-----------------------------------------------------
City | BOONEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-675-2800
-----------------------------------------------------
Fax | 479-675-3406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 290 880 W. MAIN
-----------------------------------------------------
City | BOONEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-675-2800
-----------------------------------------------------
Fax | 479-675-3406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | JAMES C. FIELDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-675-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | AR4155
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | AR4627
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | AR4154
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------