Provider Demographics
NPI:1811198641
Name:WASHINGTON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:WASHINGTON REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ECKELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-463-6026
Mailing Address - Street 1:325 E LONGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4618
Mailing Address - Country:US
Mailing Address - Phone:479-713-7385
Mailing Address - Fax:479-444-7120
Practice Address - Street 1:325 E LONGVIEW ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4618
Practice Address - Country:US
Practice Address - Phone:479-463-7385
Practice Address - Fax:479-444-7120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3906251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11500OtherBLUE CROSS
AR126352747Medicaid
AR041500Medicare ID - Type Unspecified