Organization
BOSTON MOUNTAIN RURAL HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE ACKERSON (CEO)
(870) 448-5733
Entity
Organization
Contact information
Practice address
934 N GASKILL ST, HUNTSVILLE, AR 72740-8903
(479) 738-5500
(479) 738-1350
Mailing address
PO BOX 1060, MARSHALL, AR 72650-1060
(870) 448-5101
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149029749
—
AR
01
—
5B477
BLUE CROSS OF ARKANSAS GR
AR
01
—
DA1111
RAILROAD MEDICARE PIN GRO
AR
Enumeration date
09/28/2006
Last updated
01/25/2019
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