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	208D00000X	General Practice Physician

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

General Provider Information

NPI Number	:	1558691410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAXTER COUNTY REGIONAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	675 HIGHWAY 62 E STE 101
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3207
Country	:	US
Telephone Number	:	870-508-1095
Fax Number	:	870-508-1998

Provider Business Practice Location Address
First Line	:	675 HIGHWAY 62 E STE 101
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3207
Country	:	US
Telephone Number	:	870-508-1095
Fax Number	:	870-508-1998

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

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	03/14/2023

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