Provider Demographics
NPI:1821140815
Name:WASHINGTON REGIONAL MEDICORP, INC.
Entity Type:Organization
Organization Name:WASHINGTON REGIONAL MEDICORP, INC.
Other - Org Name:FAYETTEVILLE CITY HOSPITAL-TRANSITIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-713-1009
Mailing Address - Street 1:221 S SCHOOL AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5969
Mailing Address - Country:US
Mailing Address - Phone:479-442-5100
Mailing Address - Fax:479-442-7395
Practice Address - Street 1:221 S SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5969
Practice Address - Country:US
Practice Address - Phone:479-442-5100
Practice Address - Fax:479-442-7395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 2926282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR044015Medicare ID - Type UnspecifiedGERIATRIC PSYCHIATRIC HOS