Provider Demographics
NPI:1104268689
Name:BAPTIST HEALTH
Entity type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2080
Mailing Address - Street 1:1415 HIGHWAY 25B STE 3
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-1710
Mailing Address - Country:US
Mailing Address - Phone:501-887-3212
Mailing Address - Fax:
Practice Address - Street 1:1415 HIGHWAY 25B STE 3
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-1710
Practice Address - Country:US
Practice Address - Phone:501-887-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-24
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5558261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120463729Medicaid
AR043804Medicare Oscar/Certification
ARB89918Medicare UPIN
AR50148Medicare PIN