Provider Demographics
NPI:1114178753
Name:BAXTER COUNTY REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL INC
Other - Org Name:BRMC ANESTHESIA
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 1:624 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2955
Mailing Address - Country:US
Mailing Address - Phone:870-508-1000
Mailing Address - Fax:870-425-6616
Practice Address - Street 1:624 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2955
Practice Address - Country:US
Practice Address - Phone:870-508-1000
Practice Address - Fax:870-425-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176102002Medicaid
AR770091002OtherBREASTCARE