MEDICARE: CROSSETT HEALTH FOUNDATION

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	282NC0060X	Critical Access Hospital	AR4238	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56897	OTHER	AR	MEDICARE & BC PHYSICIAN #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10024	OTHER	AR	BLUE CROSS PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952308215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSETT HEALTH FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	CROSSETT
State	:	AR
Zip	:	71635-0400
Country	:	US
Telephone Number	:	870-364-4111
Fax Number	:	870-364-3636

Provider Business Practice Location Address
First Line	:	1015 UNITY RD
Second Line	:
City	:	CROSSETT
State	:	AR
Zip	:	71635-9443
Country	:	US
Telephone Number	:	870-364-4111
Fax Number	:	870-364-3636

Authorized Official
Title or Position	:	CEO
Name	:	PHILLIP K GILMORE
Credential	:
Telephone Number	:	870-364-1271

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/07/2023

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Directions to “CROSSETT HEALTH FOUNDATION ” Practice Location

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