Provider Demographics
NPI:1720430309
Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Other - Org Name:INTERVENTIONAL PAIN MANAGEMENT
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 1:825 N MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2914
Mailing Address - Country:US
Mailing Address - Phone:870-365-0130
Mailing Address - Fax:870-565-0131
Practice Address - Street 1:825 N MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2914
Practice Address - Country:US
Practice Address - Phone:870-365-0130
Practice Address - Fax:870-565-0131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAXTER COUNTY REGIONAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-07
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain