Provider Demographics
NPI:1659579118
Name:BAPTIST HEALTH HOSPITALS
Entity Type:Organization
Organization Name:BAPTIST HEALTH HOSPITALS
Other - Org Name:BAPTIST HEALTH FAMILY CLINIC BRINKLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2080
Mailing Address - Street 1:11001 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:110 N NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2722
Practice Address - Country:US
Practice Address - Phone:870-734-4405
Practice Address - Fax:870-734-3438
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-06
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR201477729Medicaid
AR129734729Medicaid
AR043457Medicare Oscar/Certification