Provider Demographics
NPI:1568433480
Name:MERCY HOSPITAL FORT SMITH
Entity Type:Organization
Organization Name:MERCY HOSPITAL FORT SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
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:479-314-1770
Practice Address - Street 1:7301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4100
Practice Address - Country:US
Practice Address - Phone:479-314-6100
Practice Address - Fax:479-314-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR412282N00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100698690AMedicaid
AR105691105Medicaid
AR10062OtherBLUE CROSS BLUE SHIELD
AR105691105Medicaid
OK100698690AMedicaid