Provider Demographics
NPI:1457893281
Name:BAXTER COUNTY REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL INC
Other - Org Name:BAXTER REGIONAL GASTROENTEROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1003
Mailing Address - Street 1:PO BOX 958539
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-8539
Mailing Address - Country:US
Mailing Address - Phone:508-475-0450
Mailing Address - Fax:
Practice Address - Street 1:228 BUCHER DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3400
Practice Address - Country:US
Practice Address - Phone:870-425-4416
Practice Address - Fax:870-425-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty