Provider Demographics
NPI:1104282664
Name:HOWARD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HOWARD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KOSTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-845-8024
Mailing Address - Street 1:130 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8606
Mailing Address - Country:US
Mailing Address - Phone:870-845-8024
Mailing Address - Fax:870-845-8027
Practice Address - Street 1:122 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8606
Practice Address - Country:US
Practice Address - Phone:870-845-6069
Practice Address - Fax:845-845-6068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5611103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR4577OtherHOSPITAL LICENSE