Provider Demographics
NPI:1417948290
Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Other - Org Name:MARSHALL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE / CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-414-5157
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650
Mailing Address - Country:US
Mailing Address - Phone:870-448-3328
Mailing Address - Fax:
Practice Address - Street 1:211 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650
Practice Address - Country:US
Practice Address - Phone:870-448-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH ARKANSAS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3203261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131315729Medicaid
AR5B481OtherBLUE CROSS BLUE SHIELD
AR131315729Medicaid