Healthcare Provider Details

I. General information

NPI: 1316980691
Provider Name (Legal Business Name): ST. VINCENT INFIRMARY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

IV. Provider business mailing address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-3150
  • Fax: 501-552-4146
Mailing address:
  • Phone: 501-552-3150
  • Fax: 501-552-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number763
License Number StateAR

VIII. Authorized Official

Name: MRS. JULIE CARPENTER
Title or Position: ADMIN DIRECTOR REVENUE CYCLE
Credential:
Phone: 501-552-3134