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	282NC0060X	Critical Access Hospital	AR3750	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11302	OTHER	AR	ARKANSAS BC/BS ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184629594
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	:	06/14/2005
Last Update Date	:	08/03/2023

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Directions to “DARDANELLE REGIONAL, LLC ” Practice Location

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