MEDICARE: CRITTENDEN HOSPITAL ASSOCIATION

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1780620534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRITTENDEN HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	105 NATHAN ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-1447
Country	:	US
Telephone Number	:	870-358-2036
Fax Number	:	870-358-4116

Provider Business Practice Location Address
First Line	:	105 NATHAN ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-1447
Country	:	US
Telephone Number	:	870-358-2036
Fax Number	:	870-358-4116

Authorized Official
Title or Position	:	DIRECTOR OF DEVELOPMENT
Name	:	RAMONA TAYLOR
Credential	:
Telephone Number	:	870-735-5527

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	04/02/2008

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