Provider Demographics
NPI:1639348949
Name:SILOAM SPRINGS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SILOAM SPRINGS MEMORIAL HOSPITAL
Other - Org Name:SSMH RADIOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-549-2434
Mailing Address - Street 1:205 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3629
Mailing Address - Country:US
Mailing Address - Phone:479-524-4141
Mailing Address - Fax:479-549-2674
Practice Address - Street 1:205 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3629
Practice Address - Country:US
Practice Address - Phone:479-524-4141
Practice Address - Fax:479-549-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR9703OtherD/B/A CERTIFICATE