Organization
BAXTER COUNTY REGIONAL HOSPITAL
Active
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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