Provider Demographics
NPI:1992916308
Name:SPARKS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:SPARKS REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS PROCESSING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CLARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-441-5365
Mailing Address - Street 1:1311 S I ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4915
Mailing Address - Country:US
Mailing Address - Phone:479-441-5365
Mailing Address - Fax:479-441-4729
Practice Address - Street 1:1311 S I ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4915
Practice Address - Country:US
Practice Address - Phone:479-441-5365
Practice Address - Fax:479-441-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045294Medicare Oscar/Certification