Provider Demographics
NPI:1124021811
Name:LEO N LEVI MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:LEO N LEVI MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:501-624-1281
Mailing Address - Street 1:300 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4003
Mailing Address - Country:US
Mailing Address - Phone:501-624-1281
Mailing Address - Fax:501-622-3343
Practice Address - Street 1:300 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4003
Practice Address - Country:US
Practice Address - Phone:501-624-1281
Practice Address - Fax:501-622-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2393282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140836726Medicaid
AR102366105Medicaid
AR11511OtherBCBS- HOSPICE
AR10132OtherBCBS PROV#
AR047151Medicare ID - Type UnspecifiedHOME HEALTH
AR041511Medicare ID - Type UnspecifiedHOSPICE
AR040132Medicare Oscar/Certification