Basic Information
| Provider Information | |||||||||
| NPI: | 1164779989 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRIM HOLDING COMPANY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WADLEY REGIONAL MEDICAL CENTER AT HOPE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 S MAIN ST | ||||||||
| Address2: | ATTN: BILLING | ||||||||
| City: | HOPE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718018124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707223800 | ||||||||
| FaxNumber: | 9037988030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOPE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718018124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707223804 | ||||||||
| FaxNumber: | 8707223840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2012 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | HOSPITAL CEO | ||||||||
| AuthorizedOfficialTelephone: | 8707223800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRIM HOLDING COMPANY, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.