Provider Demographics
NPI:1689898140
Name:ST BERNARDS COMMUNITY HOSPITAL CORP
Entity Type:Organization
Organization Name:ST BERNARDS COMMUNITY HOSPITAL CORP
Other - Org Name:CROSSRIDGE COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-238-3300
Mailing Address - Street 1:310 FALLS BLVD S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3013
Mailing Address - Country:US
Mailing Address - Phone:870-238-3300
Mailing Address - Fax:870-238-7432
Practice Address - Street 1:310 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3013
Practice Address - Country:US
Practice Address - Phone:870-238-3300
Practice Address - Fax:870-238-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4063282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57861OtherBLUE CROSS CRNA
AR120461702Medicaid