Provider Demographics
NPI:1568477123
Name:REGIONAL ORTHOPAEDIC HEALTH CARE
Entity type:Organization
Organization Name:REGIONAL ORTHOPAEDIC HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAULS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-424-3400
Mailing Address - Street 1:3 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2918
Mailing Address - Country:US
Mailing Address - Phone:870-424-3400
Mailing Address - Fax:870-424-4121
Practice Address - Street 1:3 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2918
Practice Address - Country:US
Practice Address - Phone:870-424-3400
Practice Address - Fax:870-424-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCG0920OtherRR MEDICARE
AR138975002Medicaid
AR5B111OtherBCBS
ARCG0920OtherRR MEDICARE
AR5B111OtherBCBS