Basic Information
| Provider Information | |||||||||
| NPI: | 1982149662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON MOUNTAIN RURAL HEALTH CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1060 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726501060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704485101 | ||||||||
| FaxNumber: | 8704483767 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 DOGWOOD HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725608626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
| FaxNumber: | 9999999999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2017 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | ACKERSON | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8704485733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.