Baptist Health
Organization Active NPI Rural Health Clinic/Center · Caddo Valley, AR
NPI 1104235332 · NPPES record last updated Sep 18, 2015
Key facts
- NPI
- 1104235332
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BAPTIST HEALTH
- Practice address
- 10 Montgomery Drive
Caddo Valley, AR 71923 - Phone
- (870) 245-2198
- NPI assigned
- Aug 13, 2014
- Organization subpart
- No
Authorized official
- Name
- Troy Wells
- Title
- President
- Phone
- (501) 202-2080
Other NPIs on the same Medicare enrollment 1
Related certifications (CCN) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Rural health clinic certification: CCN 048507
- Legal name
- BAPTIST HEALTH
- Doing business as
- BAPTIST HEALTH FAMILY CLINIC - CADDO VALLEY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 5, 2014
- Last certification
- Nov 1, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1920 in AR
- Enrollment address
- 10 Montgomery Dr
BHFC Caddo Valley
Caddo Valley, AR 71923-8901 - Related CCNs
- 041321
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Larry White |
Corporate Director | Jan 1, 2026 | |
| Baptist Health |
Operational/Managerial Control | Jul 7, 2014 | |
| Ronald Dedman |
Corporate Director | Jan 1, 2022 | |
| Lamarr Bailey |
Corporate Director | Jan 1, 2021 | |
| Herren Hickingbotham |
Corporate Director | Jan 1, 2014 | |
| Judy Simmons Henry |
Corporate Director | Jan 1, 2014 | |
| Michael Akin |
Corporate Director | Jan 1, 2026 | |
| Chris Brune |
Corporate Director | Jan 1, 2026 | |
| Troy Wells |
Corporate Director | Jul 1, 2014 | |
| W-2 Managing Employee | Jul 1, 2014 | ||
| Suzanne Peyton |
Corporate Director | Jan 1, 2021 | |
| John McMorran |
Corporate Director | Jan 1, 2014 | |
| Lindsey Lorence |
Corporate Director | Jan 1, 2026 | |
| Steven Booth |
Corporate Director | Jan 1, 2021 | |
| David Mitchell |
Corporate Director | Jan 1, 2026 | |
| James S Jones |
Corporate Director | Jan 1, 2014 | |
| Louis M Lee |
Corporate Director | Jan 1, 2014 | |
| Teresa Howell |
Corporate Director | Jan 1, 2021 | |
| Brent Beaulieu |
Corporate Officer | Jan 1, 2021 | |
| W-2 Managing Employee | Jan 1, 2021 | ||
| Glenn Millner |
Corporate Director | Jan 1, 2014 | |
| Les Warren |
Corporate Director | Jan 1, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140825001220 | AR | Part a Provider - Rural Health Clinic | 0648177949 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Caddo Valley, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | AR | Yes |
Addresses
Primary practice location
10 Montgomery Drive
Caddo Valley, AR 71923
Mailing address
10 Montgomery Drive
Caddo Valley, AR 71923
Phone (870) 245-2198
Other providers in Caddo Valley, AR
All providers in Caddo Valley, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2015. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.