Healthcare Provider Details

I. General information

NPI: 1124813076
Provider Name (Legal Business Name): ST BERNARDS PHYSICIAN CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E MATTHEWS AVE
JONESBORO AR
72401-3145
US

IV. Provider business mailing address

PO BOX 1331
JONESBORO AR
72403-1331
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-6799
  • Fax: 870-932-8423
Mailing address:
  • Phone: 870-932-7024
  • Fax: 870-930-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN LIEBLONG
Title or Position: PRESIDENT
Credential:
Phone: 870-932-7024