Provider Demographics
NPI:1073129755
Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Other - Org Name:MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RAYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-838-7463
Mailing Address - Street 1:1520 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1448
Mailing Address - Country:US
Mailing Address - Phone:870-838-7462
Mailing Address - Fax:870-838-7493
Practice Address - Street 1:602 W UNION AVE STE B
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3022
Practice Address - Country:US
Practice Address - Phone:870-563-6504
Practice Address - Fax:870-622-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health