Provider Demographics
NPI:1437266152
Name:ST. MARY-ROGERS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ST. MARY-ROGERS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-986-3408
Mailing Address - Street 1:1200 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3546
Mailing Address - Country:US
Mailing Address - Phone:479-986-3408
Mailing Address - Fax:479-619-3388
Practice Address - Street 1:1200 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3546
Practice Address - Country:US
Practice Address - Phone:479-986-3408
Practice Address - Fax:479-619-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B858Medicare ID - Type UnspecifiedGROUP NUMBER