BAXTER REGIONAL COMPREHENSIVE WOMEN'S CLINIC - NPI NUMBER 1598030579

Summary

Provider Name: BAXTER REGIONAL COMPREHENSIVE WOMEN'S CLINIC

NPI Number: 1598030579

Clasification: Clinic/Center (261Q00000X)

Address:
628 HOSPITAL DR
SUITE E
MOUNTAIN HOME, AR
ZIP 72653

Phone Number: (870) 508-3260



Detailed Information

BAXTER REGIONAL COMPREHENSIVE WOMEN'S CLINIC is a clinic/center in Mountain Home, AR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). The assigned NPI number for this provider is 1598030579 and is registered as an organization entity type.

The provider's business address is:

628 HOSPITAL DR
SUITE E
MOUNTAIN HOME, AR
ZIP 72653-953
Phone: (870) 508-3260

The provider's authorized official is James Rudy Darling .
The authorized official title is Coo and has the following contact phone number (870) 508-1002.

The enumeration date for this NPI number is 3/9/2012 and was last updated on 5/14/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261Q00000X Clinic/Center Yes

NPI Record

No. Field Name Field Value
1 NPI 1598030579
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name BAXTER REGIONAL COMPREHENSIVE WOMEN'S CLINIC
5 Provider First Line Business Practice Location Address 628 HOSPITAL DR
6 Provider Second Line Business Practice Location Address SUITE E
7 Provider Business Practice Location Address City Name MOUNTAIN HOME
8 Provider Business Practice Location Address State Name AR
9 Provider Business Practice Location Address Postal Code 726532953
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 8705083260
12 Provider Enumeration Date 3/9/2012
13 Last Update Date 5/14/2012
14 Authorized Official Last Name DARLING
15 Authorized Official First Name JAMES
16 Authorized Official Middle Name RUDY
17 Authorized Official Title or Position COO
18 Authorized Official Telephone Number 8705081002
19 Healthcare Provider Taxonomy Code 1 261Q00000X
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Organization Subpart Y
22 Parent Organization LBN BAXTER COUNTY REGIONAL HOSPITAL, INC
23 Parent Organization TIN
24 Authorized Official Credential Text RPH, MBA

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This page was last updated on: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.