Basic Information
Provider Information | |||||||||
NPI: | 1770802217 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MCGEHEE HOSPITAL INCORPORATED | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 351 | ||||||||
Address2: |   | ||||||||
City: | MC GEHEE | ||||||||
State: | AR | ||||||||
PostalCode: | 716540351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8702225600 | ||||||||
FaxNumber: | 8702224260 | ||||||||
Practice Location | |||||||||
Address1: | 900 S 3RD ST | ||||||||
Address2: |   | ||||||||
City: | MC GEHEE | ||||||||
State: | AR | ||||||||
PostalCode: | 716542562 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8702225600 | ||||||||
FaxNumber: | 8706904239 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/24/2010 | ||||||||
LastUpdateDate: | 08/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | AMSTUTZ | ||||||||
AuthorizedOfficialFirstName: | TERRY | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 8706904132 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X |   |   | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 11308 | 01 | AR | BLUE CROSS | OTHER | 183068105 | 05 | AR |   | MEDICAID | AR4657 | 01 | AR | LICENSE | OTHER |