Basic Information
| Provider Information | |||||||||
| NPI: | 1699169466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. VINCENT INFIRMARY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22720 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722212720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015523000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 SAINT VINCENT CIR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015223000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2015 | ||||||||
| LastUpdateDate: | 05/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | RICHERT | ||||||||
| AuthorizedOfficialFirstName: | TADD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 5015223912 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CATHOLIC HEALTH INITIATIVES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 105393002 | 05 | AR | MEDICAID |