Provider Demographics
NPI:1982157020
Name:FIVE RIVERS MEDICAL CENTER INC
Entity type:Organization
Organization Name:FIVE RIVERS MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:BARYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-892-6200
Mailing Address - Street 1:2018 HIGHWAY 67 S
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4169
Mailing Address - Country:US
Mailing Address - Phone:870-202-1048
Mailing Address - Fax:
Practice Address - Street 1:2018 HIGHWAY 67 S
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4169
Practice Address - Country:US
Practice Address - Phone:870-202-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE RIVERS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-25
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care