=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710962451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCGEHEE DESHA COUNTY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2005
-----------------------------------------------------
Last Update Date | 03/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 S 3RD ST
-----------------------------------------------------
City | MC GEHEE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71654-2563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-222-3805
-----------------------------------------------------
Fax | 870-222-3984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 351
-----------------------------------------------------
City | MC GEHEE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71654-0351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-222-3805
-----------------------------------------------------
Fax | 870-222-3984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING/STAFF NURSE
-----------------------------------------------------
Name | MS. ANGIE SNOW
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 870-222-3805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | AR4067
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------