Provider Demographics
NPI:1073518593
Name:BOONEVILLE COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:BOONEVILLE COMMUNITY HOSPITAL, INC.
Other - Org Name:BOONEVILLE COMMUNITY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-675-2800
Mailing Address - Street 1:P.O. BOX 290
Mailing Address - Street 2:880 W. MAIN
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927
Mailing Address - Country:US
Mailing Address - Phone:479-675-2800
Mailing Address - Fax:479-675-3406
Practice Address - Street 1:880 W MAIN
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927
Practice Address - Country:US
Practice Address - Phone:479-675-2800
Practice Address - Fax:479-675-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4155251E00000X
ARAR4627251E00000X
261QR1300X, 273R00000X, 275N00000X
ARAR4154282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251E00000XAgenciesHome Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No273R00000XHospital UnitsPsychiatric Unit
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136520001Medicaid
AR195067729Medicaid
AR150084757Medicaid
AR150119752Medicaid
AR150114514Medicaid
AR150111105Medicaid
AR154911729Medicaid
AR17171OtherBC HHA
DB4073OtherRAILROAD MEDICARE PIN
AR11318OtherBC HOSPITAL
AR150116765Medicaid
AR150115732Medicaid
AR150214002Medicaid
AR770002005Medicaid
AR150116765Medicaid
048502Medicare Oscar/Certification
AR150115732Medicaid
AR150084757Medicaid
AR195067729Medicaid
AR154911729Medicaid
04Z318Medicare Oscar/Certification