Provider Demographics
NPI:1821039769
Name:SIGNATURE MEDICAL PARK HOSPITAL L L C
Entity Type:Organization
Organization Name:SIGNATURE MEDICAL PARK HOSPITAL L L C
Other - Org Name:GOINS RURAL PRACTICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-722-7292
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-0601
Mailing Address - Country:US
Mailing Address - Phone:870-722-7231
Mailing Address - Fax:870-722-7192
Practice Address - Street 1:302 E 20TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8217
Practice Address - Country:US
Practice Address - Phone:870-777-8975
Practice Address - Fax:870-777-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B624OtherARKANSAS BCBS
AR5B624OtherARKANSAS BCBS