MEDICARE: SOUTH ARKANSAS REGIONAL HEALTH 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1447099056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ARKANSAS REGIONAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	2301 CHAMPAGNOLLE RD
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4816
Country	:	US
Telephone Number	:	870-865-7908
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CHAMPAGNOLLE RD
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4816
Country	:	US
Telephone Number	:	870-865-7908
Fax Number	:

Authorized Official
Title or Position	:	BILLING SPECIALIST /CREDENTIALING C
Name	:	HEATHER HOOVER
Credential	:
Telephone Number	:	870-864-2496

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/28/2024

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