Provider Demographics
NPI:1023042991
Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Other - Org Name:BAXTER HEALTH AHRENS FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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:870-508-1003
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:YELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72687-0718
Mailing Address - Country:US
Mailing Address - Phone:870-449-4221
Mailing Address - Fax:870-449-6777
Practice Address - Street 1:414 W OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687-8284
Practice Address - Country:US
Practice Address - Phone:870-449-4221
Practice Address - Fax:870-449-6777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAXTER COUNTY REGIONAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3827207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175567002Medicaid
AR127549729Medicaid
AR13432OtherARKANSAS BCBS
AR127549729Medicaid
AR57047Medicare PIN