Basic Information
| Provider Information | |||||||||
| NPI: | 1265899363 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAXTER COUNTY REGIONAL HOSPITAL, INC | ||||||||
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| OtherOrganizationName: | BAXTER REGIONAL MEDICAL SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 628 HOSPITAL DR | ||||||||
| Address2: | SUIT 1 A | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704254402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 628 HOSPITAL DR | ||||||||
| Address2: | SUIT 1 A | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704254402 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2016 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | HENRY | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8705081003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAXTER COUNTY REGIONAL HOSPITAL, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.