Provider Demographics
NPI:1588917736
Name:BRADLEY COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:BRADLEY COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-226-4301
Mailing Address - Street 1:304 E CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-3452
Mailing Address - Country:US
Mailing Address - Phone:870-226-8636
Mailing Address - Fax:870-226-8655
Practice Address - Street 1:304 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-3452
Practice Address - Country:US
Practice Address - Phone:870-226-8636
Practice Address - Fax:870-226-8655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADLEY COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196927002Medicaid