Provider Demographics
NPI:1598842643
Name:BOONEVILLE COMMUNITY HOSPITAL, INC
Entity Type:Organization
Organization Name:BOONEVILLE COMMUNITY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN (BOB)
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-675-2800
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-0290
Mailing Address - Country:US
Mailing Address - Phone:479-675-2800
Mailing Address - Fax:479-675-2881
Practice Address - Street 1:880 WEST MAIN
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-0290
Practice Address - Country:US
Practice Address - Phone:479-675-2800
Practice Address - Fax:479-675-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4154275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C893OtherBCH CLINIC
AR04Z318OtherBCH SWING BED
AR043491OtherBCH RHC
AR047171OtherBCH HOME HEALTH AGENCY
AR11318OtherARK BCBS