Provider Demographics
NPI:1407890213
Name:CRITTENDEN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CRITTENDEN MEMORIAL HOSPITAL
Other - Org Name:SENIOR HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-733-3867
Mailing Address - Street 1:304 S RHODES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4215
Mailing Address - Country:US
Mailing Address - Phone:870-733-3867
Mailing Address - Fax:870-732-7707
Practice Address - Street 1:304 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4215
Practice Address - Country:US
Practice Address - Phone:870-733-3867
Practice Address - Fax:870-732-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F396OtherBLUE CROSS GROUP