NPIMap

Organization Active NPI

Baxter County Regional Hospital

Doing business as Baxter Regional Pulmonology Clinic

  • Pulmonary Disease Physician
  • Mountain Home, AR
National Provider Identifier
1467537324
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
AR3827 Issued in AR
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL
Doing business as
Baxter Regional Pulmonology Clinic
Practice address
628 Hospital Dr Ste 3a
Mountain Home, AR 72653-2952
Phone
(870) 508-3250
NPI assigned
Oct 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ivan Holleman
Title
Cfo
Phone
(870) 508-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X AR3827 AR Primary

Addresses

Primary practice location

628 Hospital Dr Ste 3a
Mountain Home, AR 72653-2952

Mailing address

628 Hospital Dr Ste 3a
Mountain Home, AR 72653-2952
Phone (870) 508-3250

Other identifiers 1

IdentifierTypeStateIssuer
101068002MedicaidAR

Other names 1

  • Baxter Regional Pulmonology Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Baxter Cnty Reg Hosp Inc40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Locations

230 Highway 5 N
Ste 20
Mountain Home, AR 72653
Phone (870) 424-3220

624 Hospital Dr
Mountain Home, AR 72653
Phone (870) 424-1000

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467537324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 HOSPITAL DR STE 3A",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532952",
            "telephone_number": "870-508-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 HOSPITAL DR STE 3A",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532952",
            "telephone_number": "870-508-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLEMAN",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-508-1003"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AR",
            "license": "AR3827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101068002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Regional Pulmonology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.