Basic Information
| Provider Information | |||||||||
| NPI: | 1306921747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STUTTGART REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 NORTH BUERKLE | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721601905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706733511 | ||||||||
| FaxNumber: | 8706726869 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 N BUERKLE ROAD | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721601905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706733511 | ||||||||
| FaxNumber: | 8706726869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8706733511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | AR3903 | AR | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 10094105 | 05 | AR | MEDICAID | 10072 | 01 | AR | BLUE CROSS | OTHER |