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General NPI Number Information
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NPI Number | 1659400257
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Entity Type | Organization
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Legal Business Name | BAXTER COUNTY REGIONAL HOSPITAL
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 628 HOSPITAL DR STE 3A
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2952
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Country | US
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Telephone | 870-508-6020
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Fax | 870-508-6025
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Provider Business Mailing Address
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Address Line | 628 HOSPITAL DR STE 3A
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2952
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Country | US
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Telephone | 870-508-6020
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Fax | 870-508-6025
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Authorized Official
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Title or Position | CFO
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Name | DEBRA HENRY
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Credential |
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Telephone | 870-508-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | AR3827
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License Number State | AR
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