Provider Demographics
NPI:1316902414
Name:MERCY HOSPITAL ROGERS
Entity type:Organization
Organization Name:MERCY HOSPITAL ROGERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-314-6104
Mailing Address - Street 1:2710 RIFE MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-8000
Mailing Address - Fax:479-338-2906
Practice Address - Street 1:2710 RIFE MEDICAL LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-8000
Practice Address - Fax:479-338-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208VP0014X
AR2990282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO012194304Medicaid
OK100698730AMedicaid
OH0866460Medicaid
IA0987149Medicaid
AR10010OtherAR BLUE CROSS BLUE SHIELD
LA1765261Medicaid
CO95007597Medicaid
AR101109105Medicaid
TX071512001Medicaid
KS100102890AMedicaid
KS100102890AMedicaid