Provider Demographics
NPI:1578555736
Name:FORT SMITH HMA, LLC
Entity Type:Organization
Organization Name:FORT SMITH HMA, LLC
Other - Org Name:SPARKS REGIONAL MEDICAL CENTER
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 1:1001 TOWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-4921
Mailing Address - Country:US
Mailing Address - Phone:479-441-4000
Mailing Address - Fax:479-441-5420
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-5214
Practice Address - Fax:479-441-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207RG0300X
ARAR4421261QM2500X, 273Y00000X, 282N00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No273Y00000XHospital UnitsRehabilitation Unit
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105690105Medicaid
AR150325002Medicaid
AR710236920729*010000OtherTRICARE
OK100698680AMedicaid
OK100698680WMedicaid
AR10055OtherBC/BS ACUTE
AR5B370OtherAR BCBS
AR15294OtherBCBS SNF
AR045294Medicare Oscar/Certification
OK100698680AMedicaid
AR710236920729*010000OtherTRICARE
AR04S055Medicare ID - Type UnspecifiedPSYCH