Provider Demographics
NPI:1477658839
Name:BAPTIST HEALTH
Entity Type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:BAPTIST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-7480
Mailing Address - Street 1:11900 COLONEL GLENN RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2820
Mailing Address - Country:US
Mailing Address - Phone:501-202-7480
Mailing Address - Fax:
Practice Address - Street 1:3050 TWIN RIVERS DR
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4218
Practice Address - Country:US
Practice Address - Phone:870-245-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3838251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11554OtherBCBS PROVIDER NUMBER
AR130371747Medicaid
AR=========011OtherHUMANA PROVIDER NUMBER
AR=========58OtherQUALCHOICE PROVIDER NUMBE
AR041554Medicare ID - Type UnspecifiedPROVIDER NUMBER