Provider Demographics
NPI:1194732149
Name:QHG OF SPRINGDALE INC
Entity type:Organization
Organization Name:QHG OF SPRINGDALE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-757-4011
Mailing Address - Street 1:409 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5333
Mailing Address - Country:US
Mailing Address - Phone:479-751-1601
Mailing Address - Fax:479-750-6501
Practice Address - Street 1:409 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5333
Practice Address - Country:US
Practice Address - Phone:479-751-1601
Practice Address - Fax:479-750-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4234163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136145514Medicaid
AR17020OtherBCBS
AR13625742Medicaid
AR136145514Medicaid