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General NPI Number Information
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NPI Number | 1275451817
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Entity Type | Organization
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Legal Business Name | GREAT RIVER MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 602 W UNION AVE STE B
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City | OSCEOLA
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State | AR
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Zip | 72370-3022
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Country | US
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Telephone | 870-563-6504
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | BLYTHEVILLE
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State | AR
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Zip | 72316-0108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LACEY CARTER
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Credential |
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Telephone | 870-838-7460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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