Provider Demographics
NPI:1942265160
Name:MERCY HOSPITAL ROGERS
Entity Type:Organization
Organization Name:MERCY HOSPITAL ROGERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMONING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-338-2267
Mailing Address - Street 1:2710 RIFE MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-936-2978
Mailing Address - Fax:479-619-3339
Practice Address - Street 1:1200 W WALNUT ST STE 1800
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3578
Practice Address - Country:US
Practice Address - Phone:479-936-2978
Practice Address - Fax:479-619-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4108251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124311514Medicaid
AR17149OtherAR BLUE CROSS BLUE SHIELD
AR17149OtherAR BLUE CROSS BLUE SHIELD