Provider Demographics
NPI:1326486523
Name:BAXTER COUNTY REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL, INC.
Other - Org Name:BRMC CLINIC AT FLIPPIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1003
Mailing Address - Street 1:806 E MAIN
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0309
Mailing Address - Country:US
Mailing Address - Phone:870-453-2266
Mailing Address - Fax:
Practice Address - Street 1:806 E MAIN ST.
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-0309
Practice Address - Country:US
Practice Address - Phone:870-453-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAXTER COUNTY REGIONAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care