Provider Demographics
NPI:1174044697
Name:BRADLEY COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:BRADLEY COUNTY MEDICAL CENTER
Other - Org Name:BRADLEY COUNTY MEDICAL CENTER RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-226-4301
Mailing Address - Street 1:404 S BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-3459
Mailing Address - Country:US
Mailing Address - Phone:870-226-4301
Mailing Address - Fax:870-226-4378
Practice Address - Street 1:304 EAST CENTRAL
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-0000
Practice Address - Country:US
Practice Address - Phone:870-226-8636
Practice Address - Fax:870-226-8655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADLEY COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-06
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR235139729Medicaid