Provider Demographics
NPI:1376844878
Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:MISSISSIPPI COUNTY HOSPITAL SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-838-7463
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72316-0167
Mailing Address - Country:US
Mailing Address - Phone:870-838-7445
Mailing Address - Fax:
Practice Address - Street 1:1520 N DIVISION ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1448
Practice Address - Country:US
Practice Address - Phone:870-838-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR999999207L00000X, 207LP2900X, 208VP0000X, 208VP0014X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185918002Medicaid
AR185919002Medicaid
AR5B014OtherBLUECROSS BLUESHIELD OF ARKANSAS
AR5G722Medicare PIN