Provider Demographics
NPI:1891178828
Name:ST. BERNARDS HOSPITAL INC
Entity Type:Organization
Organization Name:ST. BERNARDS HOSPITAL INC
Other - Org Name:ST. BERNARDS SENIOR HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARYLSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-207-4565
Mailing Address - Street 1:225 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3111
Mailing Address - Country:US
Mailing Address - Phone:870-207-7555
Mailing Address - Fax:870-336-5083
Practice Address - Street 1:303 E MATTHEWS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3150
Practice Address - Country:US
Practice Address - Phone:870-207-7555
Practice Address - Fax:870-336-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty