Healthcare Provider Details

I. General information

NPI: 1134558398
Provider Name (Legal Business Name): ST VINCENT PHYSICIAN CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16221 SAINT VINCENT WAY
LITTLE ROCK AR
72223-9072
US

IV. Provider business mailing address

5125 NORTHSHORE DR
NORTH LITTLE ROCK AR
72118-5315
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-8150
  • Fax: 501-552-8199
Mailing address:
  • Phone: 501-224-1690
  • Fax:

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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAIME DENNIS
Title or Position: DIRECTOR-REVENUE CYCLE
Credential:
Phone: 501-224-1690