Provider Demographics
NPI:1720356207
Name:ST MARYS PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:ST MARYS PHYSICIAN SERVICES, LLC
Other - Org Name:CARDIOLOGY ASSOCIATES OF NORTH CENTRAL ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:PO BOX 9355
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9355
Mailing Address - Country:US
Mailing Address - Phone:479-968-4311
Mailing Address - Fax:479-968-4399
Practice Address - Street 1:2205 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2759
Practice Address - Country:US
Practice Address - Phone:479-968-4311
Practice Address - Fax:479-968-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty