Basic Information
| Provider Information | |||||||||
| NPI: | 1548811870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON REGIONAL MEDICAL SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727450550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794637775 | ||||||||
| FaxNumber: | 4794637187 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707413592 | ||||||||
| FaxNumber: | 8707417733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2019 | ||||||||
| LastUpdateDate: | 09/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | ECKELS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4794632825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.