Provider Demographics
NPI:1902004567
Name:BAPTIST HEALTH HOSPITALS
Entity Type:Organization
Organization Name:BAPTIST HEALTH HOSPITALS
Other - Org Name:BAPTIST HEALTH STUTTGART MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2080
Mailing Address - Street 1:11001 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:1609 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3274
Practice Address - Country:US
Practice Address - Phone:870-673-7211
Practice Address - Fax:870-673-6376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-05
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136428729Medicaid
AR201482729Medicaid
AR136428729Medicaid