NPI |
1699076737 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
2710 RIFE MEDICAL LN |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
ROGERS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
AR |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
727581452 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4793388000 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
4793382906 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
11/5/2010 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/4/2018 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
STOVER |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
BENNY |
The first name of the authorized official. |
Authorized Official Middle Name |
J |
The middle name of the authorized official. |
Authorized Official Title or Position |
VICE PRESIDENT-FINANCE |
The title or position of the authorized official. |
Authorized Official Telephone Number |
4793382230 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
2080N0001X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
208M00000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|