Basic Information
| Provider Information | |||||||||
| NPI: | 1104235332 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAPTIST HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MONTGOMERY DRIVE | ||||||||
| Address2: | |||||||||
| City: | CADDO VALLEY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702452198 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 MONTGOMERY DRIVE | ||||||||
| Address2: | |||||||||
| City: | CADDO VALLEY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702452198 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | WELLS | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5012022080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QR1300X | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.