Provider Demographics
NPI:1386687036
Name:VAN BUREN HMA LLC
Entity Type:Organization
Organization Name:VAN BUREN HMA LLC
Other - Org Name:SPARKS MEDICAL CENTER- VAN BUREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:E MAIN & SOUTH 20TH STREETS
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72957
Mailing Address - Country:US
Mailing Address - Phone:479-474-3401
Mailing Address - Fax:
Practice Address - Street 1:E MAIN & SOUTH 20TH STREETS
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72957
Practice Address - Country:US
Practice Address - Phone:479-471-4300
Practice Address - Fax:479-474-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4281282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101870105Medicaid
AR10018OtherBLUE CROSS
040018Medicare Oscar/Certification