Provider Demographics
NPI:1821249533
Name:PHYSICIANS' SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:PHYSICIANS' SPECIALTY HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:RUSS
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:479-571-7070
Mailing Address - Street 1:3873 N PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6286
Mailing Address - Country:US
Mailing Address - Phone:479-571-7070
Mailing Address - Fax:479-571-7090
Practice Address - Street 1:3873 N PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6286
Practice Address - Country:US
Practice Address - Phone:479-571-7070
Practice Address - Fax:479-571-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDP6121OtherRAILROAD MEDICARE
AR5G268OtherOUTPATIENT MEDICARE
AR10152OtherBCBS
AR180190105Medicaid
ARDP6121OtherRAILROAD MEDICARE