Provider Demographics
NPI:1194009019
Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Other - Org Name:GREAT RIVER MEDICAL CENTER-SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/CNO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAYMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-838-7460
Mailing Address - Street 1:1520 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1448
Mailing Address - Country:US
Mailing Address - Phone:870-838-7460
Mailing Address - Fax:870-838-7493
Practice Address - Street 1:1520 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1448
Practice Address - Country:US
Practice Address - Phone:870-838-7460
Practice Address - Fax:870-838-7493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4562273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit