Provider Demographics
NPI:1689432304
Name:BAXTER REGIONAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:BAXTER REGIONAL HEALTH SYSTEM
Other - Org Name:BAXTER HEALTH COCHRAN INTERNAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1003
Mailing Address - Street 1:624 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2955
Mailing Address - Country:US
Mailing Address - Phone:870-907-7024
Mailing Address - Fax:
Practice Address - Street 1:277 MAIN STREET
Practice Address - Street 2:STE 2
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554
Practice Address - Country:US
Practice Address - Phone:870-907-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty