Provider Demographics
NPI:1659611911
Name:CRITTENDEN HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CRITTENDEN HOSPITAL ASSOCIATION
Other - Org Name:CRITTENDEN REGIONAL WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-735-1500
Mailing Address - Street 1:228 TYLER
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4257
Mailing Address - Country:US
Mailing Address - Phone:870-733-5437
Mailing Address - Fax:870-733-5440
Practice Address - Street 1:228 TYLER
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4257
Practice Address - Country:US
Practice Address - Phone:870-733-5437
Practice Address - Fax:870-733-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154327002Medicaid
AR154327002Medicaid