Provider Demographics
NPI:1164493912
Name:ST EDWARD MERCY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST EDWARD MERCY MEDICAL CENTER
Other - Org Name:MERCY HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-314-6100
Mailing Address - Street 1:7301 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4100
Mailing Address - Country:US
Mailing Address - Phone:479-314-6100
Mailing Address - Fax:
Practice Address - Street 1:2713 S 74TH ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5373
Practice Address - Country:US
Practice Address - Phone:794-845-5114
Practice Address - Fax:479-484-7157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL FORT SMITH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
AR412314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15213OtherBLUE CROSS BLUE SHIELD
AR045213Medicare Oscar/Certification
AR15213OtherBLUE CROSS BLUE SHIELD