NPIMap

Organization Active NPI

Bald Knob Healthcare Center, PA

  • Clinic/Center
  • Bald Knob, AR
National Provider Identifier
1003877036
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
E2849 Issued in AR
Legal business name
BALD KNOB HEALTHCARE CENTER, PA
Practice address
2104 Highway 367 N
Bald Knob, AR 72010-9443
Phone
(501) 724-3110
Fax
(501) 724-0140
NPI assigned
Mar 29, 2006
Last updated
Nov 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tina Renee Holder
Title
Medical Office Assistant
Phone
(501) 724-3110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X E2849 AR Primary

Addresses

Primary practice location

2104 Highway 367 N
Bald Knob, AR 72010-9443

Mailing address

PO Box 1158
Bald Knob, AR 72010-1158
Phone (501) 724-3110

Other identifiers 4

IdentifierTypeStateIssuer
5C933OtherARBLUE CROSS
0100548OtherARUNITED HEATLHCARE
152204002MedicaidAR
02080000800OtherARQUALCHOICE

National Provider Directory

National Provider Directory

Locations

2104 Highway 367 N
Bald Knob, AR 72010
Phone (501) 305-1243

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257206400000",
    "number": "1003877036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1158",
            "city": "BALD KNOB",
            "state": "AR",
            "postal_code": "720101158",
            "telephone_number": "501-724-3110",
            "fax_number": "501-724-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 HIGHWAY 367 N",
            "city": "BALD KNOB",
            "state": "AR",
            "postal_code": "720109443",
            "telephone_number": "501-724-3110",
            "fax_number": "501-724-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALD KNOB HEALTHCARE CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2009-11-03",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "MEDICAL OFFICE ASSISTANT",
        "authorized_official_telephone_number": "501-724-3110",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "E2849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5C933",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEATLHCARE",
            "identifier": "0100548",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152204002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "02080000800",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bald Knob, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.