1073518593 NPI number — BOONEVILLE COMMUNITY HOSPITAL, INC.

Table of content: (NPI 1073518593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073518593 NPI number — BOONEVILLE COMMUNITY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOONEVILLE COMMUNITY 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:
Provider Other Organization Name Type Code:
6
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:
1073518593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 290
Provider Second Line Business Mailing Address:
880 W. MAIN
Provider Business Mailing Address City Name:
BOONEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-675-2800
Provider Business Mailing Address Fax Number:
479-675-3406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 W MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-675-2800
Provider Business Practice Location Address Fax Number:
479-675-3406
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
479-675-2800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  AR4155 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: AR4627 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: AR4154 , 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: 136520001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195067729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150084757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150119752 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150114514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150111105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154911729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17171 . This is a "BC HHA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: DB4073 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11318 . This is a "BC HOSPITAL" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 150116765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150115732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150214002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770002005 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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