Provider Demographics
NPI:1134119316
Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Other - Org Name:HOME HEALTH AGENCY OF NARMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-414-5155
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602
Mailing Address - Country:US
Mailing Address - Phone:870-414-4100
Mailing Address - Fax:870-414-4916
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2911
Practice Address - Country:US
Practice Address - Phone:870-414-4100
Practice Address - Fax:870-414-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3576251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130742514Medicaid
AR134058757Medicaid
AR131571763Medicaid
AR134059752Medicaid
AR155891746Medicaid
AR130741732Medicaid
AR134738754Medicaid
AR17087OtherARKANSAS BCBS NUMBER
AR155891746Medicaid