Healthcare Provider Details

I. General information

NPI: 1790729259
Provider Name (Legal Business Name): SIGNATURE MEDICAL PARK HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MAIN ST
HOPE AR
71801-8124
US

IV. Provider business mailing address

PO BOX 601
HOPE AR
71802-0601
US

V. Phone/Fax

Practice location:
  • Phone: 870-722-7231
  • Fax: 870-722-7192
Mailing address:
  • Phone: 870-722-7231
  • Fax: 870-722-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD LORENZ
Title or Position: CEO
Credential:
Phone: 870-722-2400