MEDICARE: ST. EDWARD MERCY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5B820	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1356309660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. EDWARD MERCY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 17000
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-7000
Country	:	US
Telephone Number	:	479-314-6100
Fax Number	:	479-314-1770

Provider Business Practice Location Address
First Line	:	3202 N 6TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72904-4164
Country	:	US
Telephone Number	:	479-314-6100
Fax Number	:	479-314-1770

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT/ CFO
Name	:	MR. JAMES E NEWMAN
Credential	:
Telephone Number	:	479-314-6100

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/21/2022

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Directions to “ST. EDWARD MERCY MEDICAL CENTER ” Practice Location

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