Provider Demographics
NPI:1215102702
Name:HOWARD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HOWARD MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC FINANCIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-845-6051
Mailing Address - Street 1:130 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852
Mailing Address - Country:US
Mailing Address - Phone:870-845-8024
Mailing Address - Fax:870-845-8027
Practice Address - Street 1:130 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852
Practice Address - Country:US
Practice Address - Phone:870-845-8024
Practice Address - Fax:870-845-8027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57969OtherBLUE CROSS
AR57969OtherBLUE CROSS
AR57969Medicare PIN