BOSTON MOUNTAIN RURAL HEALTH CENTER INC NPI 1174857825

NPI Information

NPI: 1174857825
Provider Name: BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 04D1107657

Address:
1103 WEST MAIN ST
GREEN FOREST, AR
ZIP 72638
Phone: (870) 438-6500
Get Directions

BOSTON MOUNTAIN RURAL HEALTH CENTER, INC is a federally qualified health center (fqhc) clinic center in Green Forest, AR. BOSTON MOUNTAIN RURAL HEALTH CENTER, INC NPI is 1174857825. The provider is registered as an organization entity type.

The provider's business location address is:

1103 WEST MAIN ST
GREEN FOREST, AR
ZIP 72638-810
Phone: (870) 438-6500
Fax: (870) 438-6615

The provider's authorized official is Debbie Ackerson .
The authorized official title is Ceo and has the following contact phone number (870) 448-5733.

The CLIA number assigned to this NPI record is 04D1107657 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/29/2009 and was last updated on 1/25/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)		ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	187063749	MEDICAID	ARKANSAS
2	041876	OTHER	ARKANSAS	MEDICARE OSCAR/ CERTIFICATION
3	5B477	OTHER	ARKANSAS	BLUE CROSS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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