1356322309 NPI number — LITTLE RIVER MEDICAL CENTER, INC.

Table of content: (NPI 1356322309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356322309 NPI number — LITTLE RIVER MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE RIVER MEDICAL CENTER, 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:
HOSPITAL HOME HEALTH
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:
1356322309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 WEST LOCKE ST., SUITE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHDOWN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-898-4120
Provider Business Mailing Address Fax Number:
870-898-3219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 WEST LOCKE ST, SUITE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHDOWN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-898-4120
Provider Business Practice Location Address Fax Number:
870-898-3219
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DOWELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
870-898-5011

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1356322309 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17139 . This is a "AR BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 131064732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133731757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133732752 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122476514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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