Organization
ST. EDWARD MERCY CLINIC, INC.
Active
Other names
Mercy Clinic River Valley Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND COLE GOODMAN JR. M.D. (PRESIDENT)
(479) 314-6100
Entity
Organization
Contact information
Practice address
3501 WE KNIGHT DRIVE, FORT SMITH, AR 72903-6248
(479) 709-6700
(479) 709-6709
Mailing address
PO BOX 11230, FORT SMITH, AR 72917-1230
(479) 709-6767
(479) 709-6768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200199350J
—
OK
01
—
5G410
BLUE CROSS BLUE SHIELD
AR
01
—
DR1533
RAILROAD MEDICARE
AR
Enumeration date
02/14/2011
Last updated
12/02/2011
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