# BAXTER REGIONAL HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BRMC Hometown Clinic at Mammoth Spring
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619516200
- **Authorized official:** LEONARD BERNARD LARRY (VICE PRESIDENT)
- **Authorized official phone:** (870) 508-1011

## Contact information

- **Practice address:** 277 MAIN STREET, MAMMOTH SPRING, AR 72554
- **Practice address phone:** (870) 269-3455
- **Mailing address:** PO BOX 1288, MOUNTAIN VIEW, AR 72560-1288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/30/2019
- **Last updated:** 12/30/2019