1578555736 NPI number — FORT SMITH HMA, LLC

Table of content: LARRY MILLER MD (NPI 1083601926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578555736 NPI number — FORT SMITH HMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT SMITH HMA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPARKS REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578555736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 TOWSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72902-4921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-441-4000
Provider Business Mailing Address Fax Number:
479-441-5420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 TOWSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72901-4921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-441-5214
Provider Business Practice Location Address Fax Number:
479-441-3793
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LALOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/DELEGATED OFFICIAL
Authorized Official Telephone Number:
615-925-4565

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: AR4421 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: AR4421 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: AR4421 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: AR4421 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105690105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150325002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710236920729*010000 . This is a "TRICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 100698680A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100698680W , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10055 . This is a "BC/BS ACUTE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5B370 . This is a "AR BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 15294 . This is a "BCBS SNF" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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