Basic Information
| Provider Information | |||||||||
| NPI: | 1588833214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. JOSEPH'S MERCY CLINIC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016092229 | ||||||||
| FaxNumber: | 5013214057 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 HIGDON FERRY RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016232731 | ||||||||
| FaxNumber: | 5016231660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2008 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5016092229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SISTERS OF MERCY HEALTH SYSTEMS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.