Provider Demographics
NPI:1982097069
Name:CHI ST. VINCENT INFIRMARY
Entity Type:Organization
Organization Name:CHI ST. VINCENT INFIRMARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:TADD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-522-3912
Mailing Address - Street 1:PO BOX 22720
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-2720
Mailing Address - Country:US
Mailing Address - Phone:501-552-3000
Mailing Address - Fax:
Practice Address - Street 1:300 WERNER ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6406
Practice Address - Country:US
Practice Address - Phone:501-622-1043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105393002Medicaid
57640Medicare PIN