Provider Demographics
NPI:1033213632
Name:BAPTIST HEALTH
Entity type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-7480
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4300
Mailing Address - Country:US
Mailing Address - Phone:501-202-7480
Mailing Address - Fax:
Practice Address - Street 1:1709 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2835
Practice Address - Country:US
Practice Address - Phone:501-206-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4203251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR17097OtherBCBS PROVIDER NUMBER
AR130611514Medicaid
AR=========58OtherQUALCHOICE PROVIDER NUMBE
AR=========74OtherTRICARE PROVIDER NUMBER
AR17097OtherBCBS PROVIDER NUMBER