=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982157020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIVE RIVERS MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 07/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2018 HIGHWAY 67 S
-----------------------------------------------------
City | POCAHONTAS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72455-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-202-1048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2018 HIGHWAY 67 S
-----------------------------------------------------
City | POCAHONTAS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72455-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-202-1048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RANDALL DEWAYNE BARYMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-892-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------