1508877697 NPI number — PIGGOTT COMMUNITY HOSPITAL

Table of content: (NPI 1508877697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508877697 NPI number — PIGGOTT COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIGGOTT COMMUNITY HOSPITAL
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:
HOMECARE MEDICAL EQUIPMENT & SUPPLIES
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:
1508877697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 GORDON DUCKWORTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIGGOTT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72454-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-598-3881
Provider Business Mailing Address Fax Number:
870-598-5915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIGGOTT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72454-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-598-3881
Provider Business Practice Location Address Fax Number:
870-598-5915
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAGEE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
870-598-3881

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  MG00327 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 9947 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 621359900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113743716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49399 . This is a "BC/BS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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