Organization
BALD KNOB HEALTHCARE CENTER, PA
Active
Organization
BALD KNOB HEALTHCARE CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA RENEE HOLDER (MEDICAL OFFICE ASSISTANT)
(501) 724-3110
Entity
Organization
Contact information
Practice address
2104 HIGHWAY 367 N, BALD KNOB, AR 72010-9443
(501) 724-3110
(501) 724-0140
Mailing address
PO BOX 1158, BALD KNOB, AR 72010-1158
(501) 724-3110
(501) 724-0140
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
E2849
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100548
UNITED HEATLHCARE
AR
01
—
02080000800
QUALCHOICE
AR
05
—
152204002
—
AR
01
—
5C933
BLUE CROSS
AR
Enumeration date
03/29/2006
Last updated
11/03/2009
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