MEDICARE: BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1174064455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARK DR
Second Line	:	SUITE C
City	:	HOLIDAY ISLAND
State	:	AR
Zip	:	72631-9216
Country	:	US
Telephone Number	:	870-448-5101
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEBBIE ACKERSON
Credential	:
Telephone Number	:	870-448-5733

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	01/28/2019

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