Basic Information
| Provider Information | |||||||||
| NPI: | 1316266851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCGEHEE HOSPITAL INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 351 | ||||||||
| Address2: | |||||||||
| City: | MC GEHEE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716540351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702225600 | ||||||||
| FaxNumber: | 8702224260 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MC GEHEE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716542562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702225600 | ||||||||
| FaxNumber: | 8706904239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2010 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | AMSTUTZ | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8706904132 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MHSA | ||||||||
| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 57687 | 01 | AR | BLUE CROSS | OTHER | 183267002 | 05 | AR | MEDICAID | 207541002 | 05 | AR | MEDICAID | 5D586 | 01 | AR | BLUE CROSS | OTHER | AR4657 | 01 | AR | LICENSE | OTHER |