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General NPI Number Information
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NPI Number | 1811255987
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Entity Type | Organization
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Legal Business Name | CROSSETT HEALTH FOUNDATION
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 1003 FRED LAGRONE DR
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City | CROSSETT
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State | AR
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Zip | 71635-4546
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Country | US
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Telephone | 870-364-3800
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Fax | 870-364-3811
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Provider Business Mailing Address
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Address Line | 1003 FRED LAGRONE DR
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City | CROSSETT
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State | AR
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Zip | 71635-4546
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Country | US
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Telephone | 870-364-3800
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Fax | 870-364-3811
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Authorized Official
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Title or Position | CEO
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Name | PHILLIP GILMORE
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Credential |
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Telephone | 870-364-1271
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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 | 282NC0060X
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License Number State | AR
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