Organization
BAXTER COUNTY REGIONAL HOSPITAL
Active
Other names
Baxter Regional Urology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA HENRY (CFO)
(870) 508-1003
Entity
Organization
Contact information
Practice address
628 HOSPITAL DR STE 3A, MOUNTAIN HOME, AR 72653-2952
(870) 508-6020
(870) 508-6025
Mailing address
628 HOSPITAL DR STE 3A, MOUNTAIN HOME, AR 72653-2952
(870) 508-6020
(870) 508-6025
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
AR3827
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101068002
—
AR
Enumeration date
03/02/2007
Last updated
03/09/2017
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