Provider Demographics
NPI:1407199490
Name:PHYSICIANS' SPECIALTY HOSPITAL
Entity Type:Organization
Organization Name:PHYSICIANS' SPECIALTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:479-571-7001
Mailing Address - Street 1:3873 N. PARKVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6286
Mailing Address - Country:US
Mailing Address - Phone:479-571-7070
Mailing Address - Fax:579-571-7090
Practice Address - Street 1:3873 N. PARKVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6286
Practice Address - Country:US
Practice Address - Phone:479-571-7070
Practice Address - Fax:579-571-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180190105Medicaid
AR180190105Medicaid
AR040152Medicare PIN
AR040152Medicare UPIN
AR040152Medicare Oscar/Certification