Provider Demographics
NPI:1326040007
Name:LITTLE RIVER MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:LITTLE RIVER MEDICAL CENTER, INC.
Other - Org Name:LITTLE RIVER MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM. ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-898-5011
Mailing Address - Street 1:451 W LOCKE ST
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-3325
Mailing Address - Country:US
Mailing Address - Phone:870-898-5011
Mailing Address - Fax:870-898-4172
Practice Address - Street 1:451 W LOCKE ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-3325
Practice Address - Country:US
Practice Address - Phone:870-898-5011
Practice Address - Fax:870-898-4172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE RIVER MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR5219282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699110AMedicaid
TX108625802Medicaid
AR238693105Medicaid
AR770033805Medicaid
AR10032OtherBCBS
AR103203105Medicaid