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 Field Definition 1
1 NPI 1598030579 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name BAXTER REGIONAL COMPREHENSIVE WOMEN'S CLINIC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 628 HOSPITAL DR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE E The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name MOUNTAIN HOME The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name AR The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 726532953 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 8705083260 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 3/9/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 5/14/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name DARLING The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name JAMES The first name of the authorized official.
16 Authorized Official Middle Name RUDY The middle name of the authorized official.
17 Authorized Official Title or Position COO The title or position of the authorized official.
18 Authorized Official Telephone Number 8705081002 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 261Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
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: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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