Provider Demographics
NPI:1710160098
Name:ST. FRANCIS HOUSE NWA, INC.
Entity Type:Organization
Organization Name:ST. FRANCIS HOUSE NWA, INC.
Other - Org Name:COMMUNITY CLINIC ROGERS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-751-7417
Mailing Address - Street 1:614 E. EMMA AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4469
Mailing Address - Country:US
Mailing Address - Phone:479-751-7417
Mailing Address - Fax:479-751-4898
Practice Address - Street 1:1233 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4245
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:479-751-2878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS HOUSE NWA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
041864Medicare Oscar/Certification