Basic Information
| Provider Information | |||||||||
| NPI: | 1699076737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES | ||||||||
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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: | 11/05/2010 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | STOVER | ||||||||
| AuthorizedOfficialFirstName: | BENNY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT-FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4793382230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.