Provider Demographics
NPI:1437423472
Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Other - Org Name:BAXTER HEALTH REPPELL DIABETES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1003
Mailing Address - Street 1:614 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2903
Mailing Address - Country:US
Mailing Address - Phone:870-508-3870
Mailing Address - Fax:
Practice Address - Street 1:614 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2903
Practice Address - Country:US
Practice Address - Phone:870-508-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAXTER COUNTY REGIONAL HOSPITAL,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center