Healthcare Provider Details

I. General information

NPI: 1164493912
Provider Name (Legal Business Name): ST EDWARD MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 S 74TH ST STE 101
FORT SMITH AR
72903-5373
US

IV. Provider business mailing address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

V. Phone/Fax

Practice location:
  • Phone: 794-845-5114
  • Fax: 479-484-7157
Mailing address:
  • Phone: 479-314-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number412
License Number StateAR

VIII. Authorized Official

Name: MS. GRETA WILCHER
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 479-314-6100