Provider Demographics
NPI:1588849665
Name:FORT SMITH HMA, LLC
Entity Type:Organization
Organization Name:FORT SMITH HMA, LLC
Other - Org Name:SPARKS REGIONAL MEDICAL CENTER REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP AND GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:1001 TOWSON AVE
Mailing Address - Street 2:PO BOX 17006
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:479-441-5365
Practice Address - Fax:479-441-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4421273Y00000X
283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15294OtherBCBS SNF
OK100698680AMedicaid
AR105690105Medicaid
AR10055OtherBCBS ACUTE CARE
710236920729010000OtherTRICARE
AR105690105Medicaid
OK100698680AMedicaid
040055Medicare Oscar/Certification
AR04T055Medicare PIN