Provider Demographics
NPI:1619219474
Name:MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Entity Type:Organization
Organization Name:MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-338-2230
Mailing Address - Street 1:2708 RIFE MEDICAL LN
Mailing Address - Street 2:SUITE T20
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-3720
Mailing Address - Fax:479-338-3740
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE T20
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1469
Practice Address - Country:US
Practice Address - Phone:479-338-3720
Practice Address - Fax:479-338-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty