Basic Information
| Provider Information | |||||||||
| NPI: | 1033157375 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHI ST VINCENT HOSPITAL HOT SPRINGS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29001 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719039001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016240838 | ||||||||
| FaxNumber: | 5016221199 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 WERNER ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016240838 | ||||||||
| FaxNumber: | 5016221199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | RICHERT | ||||||||
| AuthorizedOfficialFirstName: | TADD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 5015523912 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332U00000X | Y | Suppliers | Home Delivered Meals |
ID Information
| ID | Type | State | Issuer | Description | 121024753 | 05 | AR | MEDICAID |