Basic Information
| Provider Information | |||||||||
| NPI: | 1356382329 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CRITTENDEN HOSPITAL ASSOCIATION, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CRITTENDEN REGIONAL HOSPITAL HOME HEALTH-WEST MEMPHIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707327777 | ||||||||
| FaxNumber: | 8707327773 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707327777 | ||||||||
| FaxNumber: | 8707327773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 02/08/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CASHMAN | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8707351500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CRITTENDEN HOSPITAL ASSOCIATION, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | AR4086 | AR | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 117827514 | 05 | AR | MEDICAID | 17341 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER |