Provider Demographics
NPI:1770580995
Name:DREW COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DREW COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-460-3585
Mailing Address - Street 1:778 SCOGIN DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5729
Mailing Address - Country:US
Mailing Address - Phone:870-460-3585
Mailing Address - Fax:
Practice Address - Street 1:821 HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-7901
Practice Address - Country:US
Practice Address - Phone:870-460-3585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DREW COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4466251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102155514Medicaid
AR17082OtherBLUE CROSS HOME HEALTH
AR17082OtherBLUE CROSS HOME HEALTH