=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841379161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEO N LEVI MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 09/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 PROSPECT AVE
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-624-1281
-----------------------------------------------------
Fax | 501-622-3343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 PROSPECT AVE
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-624-1281
-----------------------------------------------------
Fax | 501-622-3343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | MR. PATRICK G MCCABE JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-622-3497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------