1134513906 NPI number — ST. VINCENT INFIRMARY MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134513906 NPI number — ST. VINCENT INFIRMARY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. VINCENT INFIRMARY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134513906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22720
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72221-2720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-522-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 WILDWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERWOOD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72120-5089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-552-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RICHERT
Authorized Official First Name:
TADD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR. VP AND CFO
Authorized Official Telephone Number:
501-522-3912

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105393002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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