Organization
BAXTER COUNTY REGIONAL HOSPITAL
Active
Other names
Baxter Regional Pulmonology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN HOLLEMAN (CFO)
(870) 508-1003
Entity
Organization
Contact information
Practice address
628 HOSPITAL DR STE 3A, MOUNTAIN HOME, AR 72653-2952
(870) 508-3250
Mailing address
628 HOSPITAL DR STE 3A, MOUNTAIN HOME, AR 72653-2952
(870) 508-3250
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
AR3827
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101068002
—
AR
Enumeration date
10/26/2006
Last updated
08/22/2020
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