Basic Information
| Provider Information | |||||||||
| NPI: | 1326486523 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAXTER COUNTY REGIONAL HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BRMC CLINIC AT FLIPPIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 806 E MAIN | ||||||||
| Address2: | |||||||||
| City: | FLIPPIN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726340309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704532266 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 806 E MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | FLIPPIN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726340309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704532266 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2013 | ||||||||
| LastUpdateDate: | 10/24/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOLLEMAN | ||||||||
| AuthorizedOfficialFirstName: | IVAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8705081003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAXTER COUNTY REGIONAL HOSPITAL, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.