1205157427 NPI number — BAXTER COUNTY REGIONAL HOSPITAL INC

Table of content: (NPI 1205157427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205157427 NPI number — BAXTER COUNTY REGIONAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAXTER COUNTY REGIONAL HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE CLINIC AT WALMART OPERATED BY BAXTER REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205157427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72654-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-492-2200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 WAL MART DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72653-6784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-492-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2010

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 185021762 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: DQ7079 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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