Basic Information
| Provider Information | |||||||||
| NPI: | 1316902414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY HOSPITAL ROGERS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | MERCY HOSPITAL NORTHWEST ARKANSAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2710 RIFE MEDICAL LN | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793388000 | ||||||||
| FaxNumber: | 4793382906 | ||||||||
| Practice Location | |||||||||
| Address1: | 2710 RIFE MEDICAL LN | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793388000 | ||||||||
| FaxNumber: | 4793382906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARMONING | ||||||||
| AuthorizedOfficialFirstName: | TAMMI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4793382267 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 2990 | AR | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 012194304 | 05 | MO | MEDICAID | 0987149 | 05 | IA | MEDICAID | 95007597 | 05 | CO | MEDICAID | 101109105 | 05 | AR | MEDICAID | 0866460 | 05 | OH | MEDICAID | 1765261 | 05 | LA | MEDICAID | 071512001 | 05 | TX | MEDICAID | 100102890A | 05 | KS | MEDICAID | 10010 | 01 | AR | AR BLUE CROSS BLUE SHIELD | OTHER | 100698730A | 05 | OK | MEDICAID |