Healthcare Provider Details

I. General information

NPI: 1215915459
Provider Name (Legal Business Name): ST. ANTHONY'S HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 E HARDING ST
MORRILTON AR
72110-4507
US

IV. Provider business mailing address

1711 E HARDING ST
MORRILTON AR
72110-4507
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-4637
  • Fax: 501-552-5326
Mailing address:
  • Phone: 501-354-4637
  • Fax: 501-552-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5434
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberN5860
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01404
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateAR

VIII. Authorized Official

Name: TIFFANY R HOGAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 501-354-4637