ST MARY'S PHYSICIAN SERVICES LLC NPI 1124084991

NPI Information

ST MARY'S PHYSICIAN SERVICES LLC is a general practice in Russellville, AR. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee ST MARY'S PHYSICIAN SERVICES LLC NPI is 1124084991. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

101 SKYLINE DR
RUSSELLVILLE, AR
ZIP 72801-363
Phone: (479) 968-2345
Fax: (479) 890-2497

The provider's authorized official is Monic Bowman .
The authorized official title is President and has the following contact phone number (615) 920-7000.

The enumeration date for this NPI number is 4/21/2006 and was last updated on 2/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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