Provider Demographics
NPI:1013941806
Name:BOONEVILLE COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:BOONEVILLE COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-675-2800
Mailing Address - Street 1:880 W. MAIN STREET
Mailing Address - Street 2:P.O. BOX 290
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927
Mailing Address - Country:US
Mailing Address - Phone:479-675-2800
Mailing Address - Fax:479-675-2881
Practice Address - Street 1:880 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927
Practice Address - Country:US
Practice Address - Phone:479-675-2800
Practice Address - Fax:479-675-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4154282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR043491Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
AR5C893Medicare ID - Type UnspecifiedPHYSICIAN
AR041318Medicare Oscar/Certification
AR04Z318Medicare Oscar/Certification