Basic Information
| Provider Information | |||||||||
| NPI: | 1639472830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAXTER COUNTY REGIONAL HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAXTER REGIONAL BONE & JOINT CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 639 BROADMOOR CIR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704244710 | ||||||||
| FaxNumber: | 8704244780 | ||||||||
| Practice Location | |||||||||
| Address1: | 639 BROADMOOR CIR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704244710 | ||||||||
| FaxNumber: | 8704244780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | HENRY | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8705081003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.