Provider Demographics
NPI:1407266760
Name:MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Entity type:Organization
Organization Name:MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-338-2230
Mailing Address - Street 1:1110 W ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6233
Mailing Address - Country:US
Mailing Address - Phone:479-751-8440
Mailing Address - Fax:751-751-8417
Practice Address - Street 1:1110 W ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6233
Practice Address - Country:US
Practice Address - Phone:479-751-8440
Practice Address - Fax:751-751-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty