Provider Demographics
NPI:1831491554
Name:FIVE RIVERS MEDICAL CENTER INC
Entity type:Organization
Organization Name:FIVE RIVERS MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:BARYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-892-6200
Mailing Address - Street 1:304 W MARR ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-2908
Mailing Address - Country:US
Mailing Address - Phone:870-892-6070
Mailing Address - Fax:870-892-6080
Practice Address - Street 1:304 W MARR
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-2908
Practice Address - Country:US
Practice Address - Phone:870-892-6070
Practice Address - Fax:870-892-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
047148Medicare Oscar/Certification