MEDICARE: BOSTON MOUNTAIN RURAL HEALTH CENTER 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	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DA1111	OTHER	AR	RAILROAD MEDICARE GROUP

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5B477	OTHER	AR	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720096027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON MOUNTAIN RURAL HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5733
Fax Number	:	870-448-4769

Provider Business Practice Location Address
First Line	:	2263 HIGHWAY 65 NORTH
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5733
Fax Number	:	870-448-4769

Authorized Official
Title or Position	:	CEO
Name	:	DEBBIE ACKERSON
Credential	:
Telephone Number	:	870-448-5733

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	01/25/2019

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Directions to “BOSTON MOUNTAIN RURAL HEALTH CENTER INC ” Practice Location

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