Provider Demographics
NPI:1265040398
Name:BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-448-5733
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:358 EAST VALLEY STREET
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687-0409
Practice Address - Country:US
Practice Address - Phone:870-449-7011
Practice Address - Fax:870-449-7010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental