Provider Demographics
NPI:1447699434
Name:MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Entity type:Organization
Organization Name:MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-338-2230
Mailing Address - Street 1:701 SW REGIONAL AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0001
Mailing Address - Country:US
Mailing Address - Phone:479-268-7640
Mailing Address - Fax:479-254-2951
Practice Address - Street 1:701 SW REGIONAL AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-0001
Practice Address - Country:US
Practice Address - Phone:479-268-7640
Practice Address - Fax:479-254-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
AR207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty