Baxter County Regional Hospital Inc.
Organization Active NPI Urology Physician · Mountain Home, AR
NPI 1003086646 · NPPES record last updated Oct 3, 2019
Key facts
- NPI
- 1003086646
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- License
- E4783 (AR)
- Legal business name
- BAXTER COUNTY REGIONAL HOSPITAL INC.
- Practice address
- 628 Hospital Dr
Suite 3a
Mountain Home, AR 72653-2953 - Phone
- (870) 508-6020
- Fax
- (870) 508-6025
- NPI assigned
- Mar 11, 2008
- Organization subpart
- No
Authorized official
- Name
- Debra Henry
- Title
- Cfo
- Phone
- (870) 508-1033
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 15
Member of 1
Practitioners 82
-
Brandi Dawn Anderson, APN
-
Daniel B Decker, MD
-
Julie Kaylan Hutchens, APRN
-
Amy L Reano, NP-C
-
Patricia Acklin, APRN
-
Nestor Arita, MD
-
Cherisse Melissa Baldeo, M.D.
-
Frank Michael Bauer, M.D.
-
Lucas Bradley, MD
-
Shannon Castle, APRN
-
Victor S Chu, M.D.
-
Almas Chughtai, MD
-
Witold Pawel Czerwinski, M.D.
-
Lorie Kay Davidson, APRN
-
Dahlia Distin, CNP
-
William Stephen Dyer, M.D.
-
Michael Elkins, MD
-
Fredric L Fredlund, APRN
-
Allan C Gocio, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR, MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080515000349 | AR | Part B Supplier - Clinic/Group Practice | 0042389264 |
Receives reassigned benefits from 7 practitioners Practice locations: Ash Flat, AR; Harrison, AR; Melbourne, AR; Mountain Home, AR; Mountain View, AR |
| O20220203001897 | MO | Part B Supplier - Clinic/Group Practice | 0042389264 |
Receives reassigned benefits from 1 practitioner Practice locations: West Plains, MO |
National Provider Directory
- Tax ID family
- Baxter Co Reg Hospital Inc
Locations
628 Hospital Dr
Ste 3A
Mountain Home, AR 72653
Phone (870) 425-1787
628 Hospital Dr
Ste 2B
Mountain Home, AR 72653
Phone (870) 508-2950
1402 N Kentucky Ave
Ste 1
West Plains, MO 65775
Phone (870) 508-6020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | E4783 | AR | Yes |
Addresses
Primary practice location
628 Hospital Dr
Suite 3a
Mountain Home, AR 72653-2953
Mailing address
628 Hospital Dr
Suite 3a
Mountain Home, AR 72653-2953
Phone (870) 508-6020
Other names
- Baxter Regional Urology Clinic
Other providers in Mountain Home, AR
- Baxter County Regional Hospital Inc
- Baxter County Regional Hospital Inc
- Baxter County Regional Hospital Inc
- Baxter County Regional Hospital Inc
- Baxter County Regional Hospital Inc
- Baxter County Regional Hospital Inc.
- Baxter County Regional Hospital, Inc
- Baxter County Regional Hospital, Inc
- Baxter County Regional Hospital, Inc
- Baxter County Regional Hospital, Inc
All providers in Mountain Home, AR · Urology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.