Provider Demographics
NPI:1659613362
Name:CRITTENDEN HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CRITTENDEN HOSPITAL ASSOCIATION
Other - Org Name:CRITTENDEN REGIONAL FAMILY PRACTICE 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 1:303 BANCARIO RD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 BANCARIO RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2220
Practice Address - Country:US
Practice Address - Phone:870-735-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty