Provider Demographics
NPI:1275523912
Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Other - Org Name:NORTH ARKANSAS MEDICAL CENTER, BOONE COUNTY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-414-5157
Mailing Address - Street 1:620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2911
Mailing Address - Country:US
Mailing Address - Phone:870-414-4000
Mailing Address - Fax:
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:870-414-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4480282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010723500Medicaid
AR131319105Medicaid
AR10017OtherBLUE CROSS BLUE SHEILD
AR131319105Medicaid