Provider Demographics
NPI:1184629594
Name:DARDANELLE REGIONAL, LLC
Entity Type:Organization
Organization Name:DARDANELLE REGIONAL, LLC
Other - Org Name:DARDANELLE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-229-4677
Mailing Address - Street 1:200 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3802
Mailing Address - Country:US
Mailing Address - Phone:479-229-4677
Mailing Address - Fax:479-229-6162
Practice Address - Street 1:200 N 3RD ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3802
Practice Address - Country:US
Practice Address - Phone:479-229-4677
Practice Address - Fax:479-229-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3750282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11302OtherARKANSAS BC/BS ID
AR109808002Medicaid
AR106601105Medicaid