Provider Demographics
NPI:1275565491
Name:SOUTHWEST ARKANSAS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SOUTHWEST ARKANSAS HEALTHCARE, LLC
Other - Org Name:TRI-LAKES MEDICAL CENTER ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-285-3182
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:71958-0000
Mailing Address - Country:US
Mailing Address - Phone:870-285-3182
Mailing Address - Fax:870-285-3305
Practice Address - Street 1:315 EAST 13TH STREET
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:AR
Practice Address - Zip Code:71958-0000
Practice Address - Country:US
Practice Address - Phone:870-285-3182
Practice Address - Fax:870-285-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR82171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158153002Medicaid
AR5F344OtherBLUE CROSS & BLUE SHIELD
AR158153002Medicaid