Provider Demographics
NPI:1922043686
Name:ST BERNARDS HOSPITAL INC
Entity Type:Organization
Organization Name:ST BERNARDS HOSPITAL INC
Other - Org Name:ST BERNARDS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-4429
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:870-972-4100
Mailing Address - Fax:870-974-5112
Practice Address - Street 1:225 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3111
Practice Address - Country:US
Practice Address - Phone:870-972-4100
Practice Address - Fax:870-974-5112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST BERNARDS HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4053282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR268358OtherBLACK LUNG
MOBLUE CROSS OF MOOther10AR307
AR10020OtherBLUE CROSS
AR101693105Medicaid
MO010327302Medicaid
WA29280OtherWASHINGTON IND. ST. FUND
AR10020OtherBLUE CROSS
AR101693105Medicaid