Provider Demographics
NPI:1962719856
Name:LITTLE RIVER MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:LITTLE RIVER MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM. ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-898-5011
Mailing Address - Street 1:450 W LOCKE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-3326
Mailing Address - Country:US
Mailing Address - Phone:870-898-5011
Mailing Address - Fax:870-898-4172
Practice Address - Street 1:370 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-2750
Practice Address - Country:US
Practice Address - Phone:870-898-4100
Practice Address - Fax:870-898-5791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE RIVER MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-13
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G384OtherBCS
AR191446002Medicaid
AR05G790Medicare Oscar/Certification