Organization
CRITTENDEN HOSPITAL ASSOCIATION
Active
Other names
Mid-South Multi Specialty Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM B MCCORMICK (CFO)
(870) 735-1500
Entity
Organization
Contact information
Practice address
228 W TYLER AVE, SUITE 105, WEST MEMPHIS, AR 72301-4223
(870) 735-4025
(870) 735-0570
Mailing address
228 W TYLER AVE, SUITE 105, WEST MEMPHIS, AR 72301-4223
(870) 735-4025
(870) 735-0570
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
N8431
AR
207RI0200X
Infectious Disease Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166512002
—
AR
01
—
5F794
BLUE CROSS GROUP
AR
Enumeration date
04/25/2006
Last updated
02/26/2014
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