Provider Demographics
NPI:1003821703
Name:BAPTIST HEALTH
Entity Type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:BAPTIST HEALTH FAMILY CLINIC GREERS FERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2080
Mailing Address - Street 1:8544 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GREERS FERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72067-9401
Mailing Address - Country:US
Mailing Address - Phone:501-825-8800
Mailing Address - Fax:501-825-6319
Practice Address - Street 1:8544 EDGEMONT RD
Practice Address - Street 2:
Practice Address - City:GREERS FERRY
Practice Address - State:AR
Practice Address - Zip Code:72067-9401
Practice Address - Country:US
Practice Address - Phone:501-825-8800
Practice Address - Fax:501-825-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130610729Medicaid
AR5B118OtherBC/BS PROVIDER #
AR130610729Medicaid