Provider Demographics
NPI:1912017815
Name:ALLEGIANCE HOSPITAL OF NORTH LITTLE ROCK, LLC
Entity Type:Organization
Organization Name:ALLEGIANCE HOSPITAL OF NORTH LITTLE ROCK, LLC
Other - Org Name:NORTH METRO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-985-7000
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0159
Mailing Address - Country:US
Mailing Address - Phone:501-985-7000
Mailing Address - Fax:501-985-7247
Practice Address - Street 1:1400 BRADEN ST.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-985-7000
Practice Address - Fax:501-985-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3795273R00000X
ARAR4519273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1S074OtherBLUE CROSS AR
AR128360105Medicaid
AR04S074Medicare ID - Type UnspecifiedGERO-PSYCH