Provider Demographics
NPI:1922041490
Name:ST. VINCENT INFIRMARY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. VINCENT INFIRMARY MEDICAL CENTER
Other - Org Name:ST. VINCENT DOCTOR'S HOSP OUTPATIENT PSYCHIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-552-3134
Mailing Address - Street 1:2 SAINT VINCENT CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5423
Mailing Address - Country:US
Mailing Address - Phone:501-552-3150
Mailing Address - Fax:501-552-4146
Practice Address - Street 1:6101 SAINT VINCENT CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5340
Practice Address - Country:US
Practice Address - Phone:501-552-3150
Practice Address - Fax:501-552-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3596261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04S007Medicare Oscar/Certification