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General NPI Number Information
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NPI Number | 1295893220
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Entity Type | Organization
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Legal Business Name | GRAVETTE MEDICAL CENTER HOSPITAL
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 JACKSON ST SW
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City | GRAVETTE
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State | AR
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Zip | 72736-9121
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Country | US
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Telephone | 479-787-5291
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Fax | 479-787-7890
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Provider Business Mailing Address
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Address Line | PO BOX 450
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City | GRAVETTE
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State | AR
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Zip | 72736-0450
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Country | US
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Telephone | 479-787-5291
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Fax | 479-787-7890
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Authorized Official
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Title or Position | INTERIM CEO
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Name | MR. WILLIAM SPARKS
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Credential |
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Telephone | 479-787-5291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | AR4284
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License Number State | AR
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