# BAXTER REGIONAL CENTER FOR INTEGRATIVE MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922475045
- **Authorized official:** MR. RON PETERSON (MANAGER)
- **Authorized official phone:** (870) 508-1018

## Contact information

- **Practice address:** 610 BROADMOOR DR, MOUNTAIN HOME, AR 72653-2903
- **Practice address phone:** (870) 508-7530
- **Mailing address:** 610 BROADMOOR DR, MOUNTAIN HOME, AR 72653-2903
- **Mailing address phone:** (870) 508-7530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E2090 | AR | Yes |

## Other

- **Enumeration date:** 08/24/2015
- **Last updated:** 08/24/2015