Basic Information
| Provider Information | |||||||||
| NPI: | 1124066469 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. JOSEPH'S MERCY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29001 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719039001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016221921 | ||||||||
| FaxNumber: | 5016221199 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 WERNER ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016221108 | ||||||||
| FaxNumber: | 5016221199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSEN | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5016221108 | ||||||||
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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 | 314000000X | AR4060 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.