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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