Organization
ST MARYS PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE LAWRENCE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
101 SKYLINE DR, RUSSELLVILLE, AR 72801-3363
(479) 968-2345
(479) 890-2497
Mailing address
101 SKYLINE DR, RUSSELLVILLE, AR 72801-3363
(479) 968-2345
(479) 890-2497
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152955002
—
AR
Enumeration date
05/09/2007
Last updated
09/26/2024
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