Provider Demographics
NPI:1730737131
Name:DARDANELLE REGIONAL, LLC
Entity type:Organization
Organization Name:DARDANELLE REGIONAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-229-4677
Mailing Address - Street 1:200 N 3RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3802
Mailing Address - Country:US
Mailing Address - Phone:479-229-6191
Mailing Address - Fax:479-229-6194
Practice Address - Street 1:200 N 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3802
Practice Address - Country:US
Practice Address - Phone:479-229-6191
Practice Address - Fax:479-229-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty