Organization
ST. VINCENT INFIRMARY MEDICAL CENTER
Active
Other names
ST VINCENT NORTH ANESTHESIA GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE CARPENTER (CEO)
(501) 552-3155
Entity
Organization
Contact information
Practice address
2215 WILDWOOD AVE, SHERWOOD, AR 72120-5089
(501) 552-7100
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149329002
—
AR
01
—
171943200
US DEPT OF LABOR
AR
01
—
5C759
BLUE CROSS OF AR
AR
Enumeration date
05/20/2006
Last updated
04/15/2010
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