Organization
ST MARY'S 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
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152955002
—
AR
01
—
DA8026
RAILROAD MEDICARE PTAN
—
Enumeration date
04/21/2006
Last updated
09/26/2024
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