MEDICARE: BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER

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
2	282NC0060X	Critical Access Hospital	AR4114	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11317	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1306826029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	201 NORTH CLIFTON STREET
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742
Country	:	US
Telephone Number	:	870-352-6363
Fax Number	:	870-352-6343

Provider Business Practice Location Address
First Line	:	201 NORTH CLIFTON STREET
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742
Country	:	US
Telephone Number	:	870-352-6363
Fax Number	:	870-352-6343

Authorized Official
Title or Position	:	ADMINISTRATOR / CEO
Name	:	KENNETH E SANDERS
Credential	:
Telephone Number	:	870-352-6363

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	05/18/2017

Similar Medicare Providers

1366449068 — TERESA WHITE
Practice Location Address:

1606 WEST 4TH STREET
FORDYCE, AR
71742-1904

Practice Phone: 870-352-3338
Practice Fax: 870-352-3368

1992706824 — DALLAS COUNTY NURSING HOME
Practice Location Address:

203 N CLIFTON ST
FORDYCE, AR
71742-3026

Practice Phone: 870-352-3625
Practice Fax: 870-352-5053

1528055910 — THOMAS L WARMACK PD
Practice Location Address:

908 W 4TH ST
FORDYCE, AR
71742-2216

Practice Phone: 870-352-2161
Practice Fax: 870-352-3236

1669423810 — WARMACK PHARMACIES INC
Practice Location Address:

802 W 4TH ST
FORDYCE, AR
71742

Practice Phone: 870-352-2161
Practice Fax: 870-352-3236

1184662140 — DR. PATRICK PAUL MOSELEY JR. D.D.S.
Practice Location Address:

305 N SPRING ST
FORDYCE, AR
71742-3317

Practice Phone: 870-352-5161
Practice Fax: 870-352-7510

1912941220 — FORDYCE COUNSELING CLINIC, INC.
Practice Location Address:

1101 W 3RD ST
FORDYCE, AR
71742-3014

Practice Phone: 870-352-5122
Practice Fax: 870-352-5127

Directions to “BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.