NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Quitman, AR
National Provider Identifier
1831879824
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC.
Practice address
130 4TH St
Quitman, AR 72131-9289
Phone
(888) 602-3647
Fax
(888) 571-3256
NPI assigned
Jul 24, 2023
Last updated
Aug 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

130 4TH St
Quitman, AR 72131-9289

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230911000692 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Quitman, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831879824. Details of each certification follow.

Federally qualified health center certification: CCN 041039

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2023
Last certification
Sep 8, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1997 in AR
Enrollment address
130 4TH St
Quitman, AR 72131-9289

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2286102Boston Mountain Rural Health Center - Quitman130 Fourth Street, Quitman, AR 72131Certificate of waiverJul 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bmrhc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

130 4th St
Quitman, AR 72131
Phone (888) 602-3647

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Debbie Ackerson Individual Corporate Officer Jun 5, 2017
Christopher Graham Individual Corporate Director Jan 1, 1999
Donna Samples Individual Corporate DirectorBoard Member Jan 1, 2003
Rebecca Blair Individual Corporate OfficerCfo Dec 16, 2013
W-2 Managing Employee Dec 16, 2013

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1831879824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5733",
            "fax_number": "870-448-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 4TH ST",
            "city": "QUITMAN",
            "state": "AR",
            "postal_code": "721319289",
            "telephone_number": "888-602-3647",
            "fax_number": "888-571-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quitman, AR

Sources for this page

Verify at the official NPI Registry.