Basic Information
| Provider Information | |||||||||
| NPI: | 1669411302 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLE ROCK HMA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHWEST REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11401 INTERSTATE 30 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722097042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014557100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11401 INTERSTATE 30 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722097042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014557100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PARRY | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VP AND GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 2395983176 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ESQ | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | AR4165 | AR | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 133171105 | 05 | AR | MEDICAID | 10021 | 01 | AR | BC ARKANSAS | OTHER |