Organization
ST.JOSEPH'S PET CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRI COUCH (MANAGER)
(479) 968-7930
Entity
Organization
Contact information
Practice address
1 MERCY LANE, SUITE 105, HOT SPRINGS, AR 71913
(877) 223-3988
(479) 968-4331
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-7930
(479) 968-4331
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C739
BCBS PROVIDER NUMBER
AR
Enumeration date
04/11/2006
Last updated
08/22/2020
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