Provider Demographics
NPI:1558140822
Name:ST BERNARDS PHYSICIAN CLINICS INC
Entity Type:Organization
Organization Name:ST BERNARDS PHYSICIAN CLINICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7024
Mailing Address - Street 1:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1331
Mailing Address - Country:US
Mailing Address - Phone:870-932-7024
Mailing Address - Fax:870-930-9377
Practice Address - Street 1:201 E OAK AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4163
Practice Address - Country:US
Practice Address - Phone:870-935-6729
Practice Address - Fax:870-268-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty