Basic Information
Provider Information | |||||||||
NPI: | 1952544389 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MISSISSIPPI COUNTY HOSPITAL SYSTEM | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SMC MEDICAL CENTER - PRO FEE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 108 | ||||||||
Address2: |   | ||||||||
City: | BLYTHEVILLE | ||||||||
State: | AR | ||||||||
PostalCode: | 723160108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8708387445 | ||||||||
FaxNumber: | 8708387492 | ||||||||
Practice Location | |||||||||
Address1: | 611 W LEE AVE | ||||||||
Address2: |   | ||||||||
City: | OSCEOLA | ||||||||
State: | AR | ||||||||
PostalCode: | 723703001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8708387445 | ||||||||
FaxNumber: | 8708387492 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/15/2009 | ||||||||
LastUpdateDate: | 04/15/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MILLER | ||||||||
AuthorizedOfficialFirstName: | DENIS | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
AuthorizedOfficialTelephone: | 8708387445 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X |   |   | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.