Basic Information
| Provider Information | |||||||||
| NPI: | 1699023895 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON REGIONAL MEDICAL SYSTEM | ||||||||
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| OtherOrganizationName: | CROSSROADS MEDICAL CLINIC - WASHINGTON REGIONAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 HIGHWAY 62 65 N | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726011959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707413600 | ||||||||
| FaxNumber: | 8707416800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 HIGHWAY 62 65 N | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726011959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707413600 | ||||||||
| FaxNumber: | 8707416800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2012 | ||||||||
| LastUpdateDate: | 08/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | CASH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CLINIC OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4794631390 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.