MEDICARE: ST FRANCIS HOUSE NWA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1083034029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST FRANCIS HOUSE NWA, INC

Provider Business Mailing Address
First Line	:	614 E EMMA AVE
Second Line	:	SUITE 300
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-4469
Country	:	US
Telephone Number	:	479-751-7417
Fax Number	:	479-751-4898

Provider Business Practice Location Address
First Line	:	1500 N MOUNT OLIVE ST
Second Line	:	SUITE 1
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-9509
Country	:	US
Telephone Number	:	479-524-8175
Fax Number	:	479-751-2878

Authorized Official
Title or Position	:	CEO
Name	:	JAMES SEMINGSON
Credential	:
Telephone Number	:	479-751-7417

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	01/15/2020

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