Organization
ST. VINCENT INFIRMARY MEDICAL CENTER
Active
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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