Provider Demographics
NPI:1104357961
Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER BERRYVILLE CLINIC
Entity Type:Organization
Organization Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER BERRYVILLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCIAL SERVICES/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-414-5157
Mailing Address - Street 1:620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2911
Mailing Address - Country:US
Mailing Address - Phone:870-414-4007
Mailing Address - Fax:870-414-4789
Practice Address - Street 1:408 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4320
Practice Address - Country:US
Practice Address - Phone:870-423-2320
Practice Address - Fax:870-423-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty