BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER; NPI #1346378528

Contact Information

BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER

201 NORTH CLIFTON STREET
FORDYCE, AR 71742

Phone: 870-352-6363
Fax: 870-352-6343
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Rural Health	261QR1300X	B4[14]	Rural Health Clinic

Indicates primary specialty

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

NPI Number 1346378528

LBN Legal business name BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER

Authorized official TAMARA RIEVES - (ADMINISTRATOR / CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 03/01/2007

Last updated 08/12/2016 - About 10 years ago

Identifiers

AR	License #	AR4115
AR	Medicaid	148217105

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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