Provider Demographics
NPI:1699107623
Name:BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-448-5733
Mailing Address - Street 1:326 SOUTH SIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEE BRANCH
Mailing Address - State:AR
Mailing Address - Zip Code:72013-9137
Mailing Address - Country:US
Mailing Address - Phone:501-654-2006
Mailing Address - Fax:501-654-2016
Practice Address - Street 1:326 SOUTH SIDE RD
Practice Address - Street 2:
Practice Address - City:BEE BRANCH
Practice Address - State:AR
Practice Address - Zip Code:72013-9137
Practice Address - Country:US
Practice Address - Phone:501-654-2006
Practice Address - Fax:501-654-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)