1952330151 NPI number — BAXTER COUNTY REGIONAL HOSPITAL, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952330151 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:
BAXTER HEALTH HOME HEALTH MARION COUNTY
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:
1952330151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 RYAN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTER
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72626-9175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-435-7500
Provider Business Mailing Address Fax Number:
870-435-7509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 RYAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTTER
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72626-9175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-435-7500
Provider Business Practice Location Address Fax Number:
870-435-7509
Provider Enumeration Date:
07/01/2006

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: 251E00000X , with the licence number:  AR3868 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 121544514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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