Provider Demographics
NPI:1356382329
Name:CRITTENDEN HOSPITAL ASSOCIATION, INC
Entity type:Organization
Organization Name:CRITTENDEN HOSPITAL ASSOCIATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:870-735-1500
Mailing Address - Street 1:200 W TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4223
Mailing Address - Country:US
Mailing Address - Phone:870-732-7777
Mailing Address - Fax:870-732-7773
Practice Address - Street 1:200 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4223
Practice Address - Country:US
Practice Address - Phone:870-732-7777
Practice Address - Fax:870-732-7773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITTENDEN HOSPITAL ASSOCIATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4086251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117827514Medicaid
AR17341OtherBLUE CROSS BLUE SHIELD
AR047122Medicare Oscar/Certification