Provider Demographics
NPI:1356312292
Name:MERCY HOSPITAL FORT SMITH
Entity Type:Organization
Organization Name:MERCY HOSPITAL FORT SMITH
Other - Org Name:MERCY HOSPICE
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 1:6801 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4067
Practice Address - Country:US
Practice Address - Phone:479-573-3866
Practice Address - Fax:479-573-3867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR412251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11504OtherBLUE CROSS BLUE SHIELD
AR130707747Medicaid
AR04-1504Medicare ID - Type Unspecified
AR11504OtherBLUE CROSS BLUE SHIELD