Provider Demographics
NPI:1366685992
Name:SMC-MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:SMC-MISSISSIPPI COUNTY HOSPITAL SYSTEM
Other - Org Name:SMC REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/CNO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-838-7460
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72316-0108
Mailing Address - Country:US
Mailing Address - Phone:870-838-7300
Mailing Address - Fax:870-838-7493
Practice Address - Street 1:611 W LEE AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3001
Practice Address - Country:US
Practice Address - Phone:870-838-7000
Practice Address - Fax:870-838-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X, 282NC0060X
ARAR4563282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178790105Medicaid
041316Medicare PIN
04Z316Medicare PIN