Provider Demographics
NPI:1932204344
Name:ST BERNARDS HOSPITAL INC
Entity type:Organization
Organization Name:ST BERNARDS HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-4429
Mailing Address - Street 1:2712 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1874
Mailing Address - Country:US
Mailing Address - Phone:870-932-2800
Mailing Address - Fax:
Practice Address - Street 1:2712 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1874
Practice Address - Country:US
Practice Address - Phone:870-932-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3552283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10AR307OtherBLUE CROSS OF MO
AR268358OtherBLACK LUNG
MO010217302OtherMEDICAID MISSOURI
AR10020OtherBLUE CROSS
AR101693105Medicaid
AR10020OtherBLUE CROSS
AR04S020Medicare Oscar/Certification