MEDICARE: BAXTER COUNTY REGIONAL HOSPITAL 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1518239896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAXTER COUNTY REGIONAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	444 HOSPITAL DR
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2900
Country	:	US
Telephone Number	:	870-425-7788
Fax Number	:	870-424-7457

Provider Business Practice Location Address
First Line	:	444 HOSPITAL DR
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2900
Country	:	US
Telephone Number	:	870-425-7788
Fax Number	:	870-424-7457

Authorized Official
Title or Position	:	CFO
Name	:	DEBRA HENRY
Credential	:
Telephone Number	:	870-508-1003

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	09/06/2016

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