Provider Demographics
NPI:1679564413
Name:PIGGOTT COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:PIGGOTT COMMUNITY HOSPITAL
Other - Org Name:FAMILY CARE CLINIC OF RECTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-3881
Mailing Address - Street 1:715 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RECTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72461-2705
Mailing Address - Country:US
Mailing Address - Phone:870-595-3596
Mailing Address - Fax:870-595-3598
Practice Address - Street 1:715 E 9TH ST
Practice Address - Street 2:
Practice Address - City:RECTOR
Practice Address - State:AR
Practice Address - Zip Code:72461-2705
Practice Address - Country:US
Practice Address - Phone:870-595-3596
Practice Address - Fax:870-595-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2023-10-26
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
AR146636729Medicaid
MO595941501Medicaid
AR146636729Medicaid