1447359419 NPI number — SPARKS REGIONAL MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447359419 NPI number — SPARKS REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPARKS REGIONAL MEDICAL CENTER
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:
1447359419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1824
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:
72902-1824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-709-7399
Provider Business Mailing Address Fax Number:
479-709-7053

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:
479-709-7402
Provider Business Practice Location Address Fax Number:
479-709-6809
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIDDLE
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
SPARKS PROVIDER RELATIONS MANAGER
Authorized Official Telephone Number:
479-709-7057

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 4454530011 . This is a "M-CARE DME" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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