Provider Demographics
NPI:1952308215
Name:CROSSETT HEALTH FOUNDATION
Entity Type:Organization
Organization Name:CROSSETT HEALTH FOUNDATION
Other - Org Name:ASHLEY COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-364-1271
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-0400
Mailing Address - Country:US
Mailing Address - Phone:870-364-4111
Mailing Address - Fax:870-364-3636
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-4111
Practice Address - Fax:870-364-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4238282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56897OtherMEDICARE & BC PHYSICIAN #
AR100985002Medicaid
AR10024OtherBLUE CROSS PROVIDER #
AR100953105Medicaid
AR04M323Medicare Oscar/Certification