Provider Demographics
NPI:1700968567
Name:BAXTER COUNTY REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL
Other - Org Name:BRMC HORSESHOE BEND 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 1:707 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:AR
Mailing Address - Zip Code:72512-3732
Mailing Address - Country:US
Mailing Address - Phone:870-670-5800
Mailing Address - Fax:
Practice Address - Street 1:707 THIRD ST
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:AR
Practice Address - Zip Code:72512-3732
Practice Address - Country:US
Practice Address - Phone:870-670-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101068002Medicaid
AR57876Medicare ID - Type Unspecified