Provider Demographics
NPI:1740450352
Name:BAXTER COUNTY REGIONAL HOSPITAL INC.
Entity type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1018
Mailing Address - Street 1:310 BUTTERCUP DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2921
Mailing Address - Country:US
Mailing Address - Phone:870-424-7072
Mailing Address - Fax:870-508-1338
Practice Address - Street 1:310 BUTTERCUP DR
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2921
Practice Address - Country:US
Practice Address - Phone:870-424-7072
Practice Address - Fax:870-508-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2130207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57709Medicare UPIN
AR5F972Medicare PIN