Provider Demographics
NPI:1225025646
Name:AMERIS OF OSCEOLA LLC
Entity Type:Organization
Organization Name:AMERIS OF OSCEOLA LLC
Other - Org Name:SMC REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-838-7462
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72316-0327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-838-7100
Practice Address - Street 1:611 W LEE AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3001
Practice Address - Country:US
Practice Address - Phone:870-563-7000
Practice Address - Fax:870-838-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4260282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR041316Medicare ID - Type Unspecified