MEDICARE: ALLEGIANCE HOSPITAL OF NORTH LITTLE ROCK, LLC

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	282N00000X	General Acute Care Hospital	AR3795	AR
2	282N00000X	General Acute Care Hospital	AR4519	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10074	OTHER	AR	BLUE CROSS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861451114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANCE HOSPITAL OF NORTH LITTLE ROCK, LLC

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72078-0159
Country	:	US
Telephone Number	:	501-985-7000
Fax Number	:	501-985-7247

Provider Business Practice Location Address
First Line	:	1400 BRADEN ST.
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076
Country	:	US
Telephone Number	:	501-985-7000
Fax Number	:	501-985-7247

Authorized Official
Title or Position	:	CEO
Name	:	CINDY STAFFORD
Credential	:
Telephone Number	:	501-985-7000

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/25/2015

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