Healthcare Provider Details

I. General information

NPI: 1164752994
Provider Name (Legal Business Name): CHI ST. VINCENT MEDICAL GROUP HOT SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LUZERNE ST
MOUNT IDA AR
71957-9437
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-2175
  • Fax: 870-867-4050
Mailing address:
  • Phone: 501-627-1800
  • Fax: 501-627-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN BARNETT
Title or Position: CFO
Credential:
Phone: 501-609-2229