1316902414 NPI number — MERCY HOSPITAL ROGERS

Table of content: (NPI 1316902414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316902414 NPI number — MERCY HOSPITAL ROGERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL ROGERS
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:
Provider Other Organization Name Type Code:
6
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:
1316902414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2710 RIFE MEDICAL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72758-1452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-338-8000
Provider Business Mailing Address Fax Number:
479-338-2906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2710 RIFE MEDICAL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-338-8000
Provider Business Practice Location Address Fax Number:
479-338-2906
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILCHER
Authorized Official First Name:
GRETA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
479-314-6104

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 2990 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 012194304 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100698730A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0866460 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0987149 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10010 . This is a "AR BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1765261 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95007597 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101109105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 071512001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100102890A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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