Provider Demographics
NPI:1134425721
Name:MERCY CLINIC FORT SMITH COMMUNITIES
Entity type:Organization
Organization Name:MERCY CLINIC FORT SMITH COMMUNITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:479-314-6100
Mailing Address - Street 1:5401 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3219
Mailing Address - Country:US
Mailing Address - Phone:479-314-1101
Mailing Address - Fax:479-314-4704
Practice Address - Street 1:3500 WE KNIGHT DRIVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6248
Practice Address - Country:US
Practice Address - Phone:479-709-8686
Practice Address - Fax:479-709-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care