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)		AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	041876	OTHER	AR	MEDICARE OSCAR/ CERTIFICATION

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5B477	OTHER	AR	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174857825
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	:	1103 WEST MAIN ST
Second Line	:
City	:	GREEN FOREST
State	:	AR
Zip	:	72638-2810
Country	:	US
Telephone Number	:	870-438-6500
Fax Number	:	870-438-6615

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

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	01/25/2019

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