National Provider Identifier Database

BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER
Rural Health


Contact Information

BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER
201 NORTH CLIFTON STREET
FORDYCE, AR71742
Phone: 870-352-6363
Fax: 870-352-6343
Website:
Specialty Taxonomy Code
* Rural Health 261QR1300X

* Indicates primary specialty

NPI Profile & details for BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER

NPI Number 1346378528
Legal business name
LBN
BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER
Authorized official TAMARA RIEVES - (ADMINISTRATOR / CEO)
Entity Organization
Organization subpart No
Enumeration date 03/01/2007
Last updated 08/12/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • AR License #: AR4115
  • AR Medicaid: 148217105

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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