MEDICARE: MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1841632817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES

Provider Business Mailing Address
First Line	:	200 S 20TH ST STE C
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1100
Country	:	US
Telephone Number	:	479-636-9669
Fax Number	:	479-636-0743

Provider Business Practice Location Address
First Line	:	200 S 20TH ST STE C
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1100
Country	:	US
Telephone Number	:	479-636-9669
Fax Number	:	479-636-0743

Authorized Official
Title or Position	:	VICE PRESIDENT-FINANCE
Name	:	BENNY J STOVER
Credential	:
Telephone Number	:	479-338-2230

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	04/04/2018

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