Provider Demographics
NPI:1265430508
Name:SILOAM SPRINGS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:SILOAM SPRINGS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-549-2402
Mailing Address - Street 1:205 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3629
Mailing Address - Country:US
Mailing Address - Phone:479-524-4141
Mailing Address - Fax:479-549-2645
Practice Address - Street 1:205 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3629
Practice Address - Country:US
Practice Address - Phone:479-524-4141
Practice Address - Fax:479-549-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR54282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
10001OtherBLUE CROSS FACILITY
56886OtherBLUE CROSS PHYSICIANS
04-0001Medicare ID - Type UnspecifiedFACILITY
10001OtherBLUE CROSS FACILITY