MEDICARE: SPARKS REGIONAL 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	332B00000X	Durable Medical Equipment & Medical Supplies		AR

General Provider Information

NPI Number	:	1871762930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKS REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1706
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-1706
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	1504 DODSON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5128
Country	:	US
Telephone Number	:	479-709-7435
Fax Number	:	479-709-7437

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHANNON WHITE
Credential	:
Telephone Number	:	479-441-5032

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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