MEDICARE: DARDANELLE REGIONAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC0050X	Critical Access Hospital Clinic/Center
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1114031143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARDANELLE REGIONAL, LLC

Provider Business Mailing Address
First Line	:	200 N 3RD ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3802
Country	:	US
Telephone Number	:	479-229-4677
Fax Number	:	479-229-6162

Provider Business Practice Location Address
First Line	:	200 N 3RD ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3802
Country	:	US
Telephone Number	:	479-229-4677
Fax Number	:	479-229-6162

Authorized Official
Title or Position	:	CONTROLLER
Name	:	BRANDY TALLEY
Credential	:
Telephone Number	:	479-229-4677

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/19/2025

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Directions to “DARDANELLE REGIONAL, LLC ” Practice Location

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