Provider Demographics
NPI:1871508663
Name:ST. GEORGE
Entity Type:Organization
Organization Name:ST. GEORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-6980
Mailing Address - Street 1:5800 W 10TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1752
Mailing Address - Country:US
Mailing Address - Phone:501-227-6980
Mailing Address - Fax:501-227-8144
Practice Address - Street 1:5800 W 10TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1752
Practice Address - Country:US
Practice Address - Phone:501-227-6980
Practice Address - Fax:501-227-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR1676261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery