Provider Demographics
NPI:1003086646
Name:BAXTER COUNTY REGIONAL HOSPITAL INC.
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL INC.
Other - Org Name:BAXTER REGIONAL UROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1033
Mailing Address - Street 1:628 HOSPITAL DR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2953
Mailing Address - Country:US
Mailing Address - Phone:870-508-6020
Mailing Address - Fax:870-508-6025
Practice Address - Street 1:628 HOSPITAL DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2953
Practice Address - Country:US
Practice Address - Phone:870-508-6020
Practice Address - Fax:870-508-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4783208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F975Medicare PIN