Provider Demographics
NPI:1295774917
Name:MERCY HOSPITAL WALDRON
Entity type:Organization
Organization Name:MERCY HOSPITAL WALDRON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE MERCY CAH
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLOUSE DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-8439
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:479-314-4740
Practice Address - Street 1:100 N WALNUT AVE STE A
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:AR
Practice Address - Zip Code:72944-3522
Practice Address - Country:US
Practice Address - Phone:479-928-4404
Practice Address - Fax:479-928-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4196261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F644OtherBLUE CROSS BLUESHIELD
AR162620729Medicaid
AR5F644OtherBLUE CROSS BLUESHIELD
AR04-3493Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC PROV#