Basic Information
| Provider Information | |||||||||
| NPI: | 1407960271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGHILL MEDICAL SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BRADLEY MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391000 | ||||||||
| FaxNumber: | 3185394085 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 WOODRUFF ST | ||||||||
| Address2: | |||||||||
| City: | BRADLEY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718268715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708943366 | ||||||||
| FaxNumber: | 8708943760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | PATRONIS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3185391001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPRINGHILL MEDICAL SERVICES, INC. | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 134262002 | 05 | AR | MEDICAID |