ST MARY'S PHYSICIAN SERVICES LLC (NPI# 1124084991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124084991 |
| Entity Type | Organization |
| Organization Name | ST MARY'S PHYSICIAN SERVICES LLC |
| Practice Address |
101 Skyline Dr Russellville AR 72801-3363 |
| Practice Telephone | 4799682345 |
| Practice Fax Number | 4798902497 |
| Mailing Telephone | 4799682345 |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2019-06-16 |
| Authorized Official Name | KATHY J TEAGUE (SECRETARY) |
| Authorized Official Telephone | 6159207000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE PTAN | DA8026 | 01 | |
| AR | 152955002 | 05 |
| Street Address |
101 SKYLINE DR |
| City | RUSSELLVILLE |
| State | AR |
| Zip Code | 72801-3363 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619971140 | Carl I Schoenberger | Internal Medicine | 101 Skyline Dr, Russellville, AR 72801-3363 | 2005-06-13 |
| 1912486648 | Kendra Leann Hubbard | Nurse Practitioner | 101 Skyline Dr, Russellville, AR 72801-3363 | 2018-08-13 |
| 1790286904 | Brittany Lasha Burris | Nurse Practitioner | 101 Skyline Dr, Russellville, AR 72801-3363 | 2018-02-22 |
| 1891294443 | Ashley Nicole Baker | Nurse Practitioner | 101 Skyline Dr, Russellville, AR 72801-3363 | 2018-02-09 |
| 1508233701 | Sparta Corp | Family Medicine | 101 Skyline Dr, Russellville, AR 72801-3363 | 2015-08-24 |
| 1467835611 | Keena Melton | Registered Nurse | 101 Skyline Dr, Russellville, AR 72801-3363 | 2015-07-07 |
| 1194144964 | Noma Wilkinson Kellner | Nurse Practitioner | 101 Skyline Dr, Russellville, AR 72801-3363 | 2014-04-09 |
| 1992049241 | Sarah Minoo Azami | Nurse Practitioner | 101 Skyline Dr, Russellville, AR 72801-3363 | 2012-11-26 |
| 1629336078 | Jonathan David Brixey | Internal Medicine | 101 Skyline Dr, Russellville, AR 72801-3363 | 2012-04-23 |
| 1629343868 | Kelly A Traylor | Nurse Practitioner | 101 Skyline Dr, Russellville, AR 72801-3363 | 2012-03-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002782 | Randy Paul Stayton | Pharmacist | 2109 W Main, Russellville, AR 72801 | 2020-10-30 |
| 1871134825 | Just Spreading Love Senior Care LLC | Student in an Organized Health Care Education/Training Program | 1411 N. Pittsburg Avenue, Russellville, AR 72801 | 2019-10-01 |
| 1124670369 | Richard L Morgan Dds Pa | Dentist | 1700 West C Place, Russellville, AR 72801 | 2019-07-09 |
| 1407342371 | Andrew James Hickman | Optometrist | 2711 E Parkway Drive, Russellville, AR 72801 | 2018-07-03 |
| 1154859833 | Felicia Head | Speech-Language Pathologist | 220 W 10th St., Russellville, AR 72801 | 2017-05-25 |
| 1295281293 | Arkansas Liver and Gastroenterology, P.a. | Internal Medicine | 1605 West Main Street, Russellville, AR 72801 | 2016-08-30 |
| 1467802405 | Kah Development 4, LLC | Hospice Care, Community Based | 3801 W Main St Ste A, Russellville, AR 72801 | 2016-06-21 |
| 1871904839 | Sleep Partners, LLC | Clinic/Center | 1310 West B Street, Suite A, Russellville, AR 72801 | 2014-05-13 |
| 1942647029 | Rpi Sleep Complete LLC | Clinic/Center | 1310 West Main Street, Suite 201, Russellville, AR 72801 | 2013-05-29 |
| 1184967291 | Amedco Arkansas Pllc | Optometrist | 302 N. Phoenix Ave., Clark Eye Clinic, Russellville, AR 72801 | 2013-03-27 |
| Find all providers in zip 72801 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588136428 | Arkansas Tech University | General Practice | 1306 N El Paso Ave, Russellville, AR 72801-8814 | 2018-12-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790382059 | Landmark Medical of Arkansas Pa | General Practice | 425 W Capitol Ave Ste 425, Little Rock, AR 72201-3424 | 2020-10-08 |
| 1306480231 | Command Radiology Solutions, Inc. | General Practice | 3708 Pilot Grove Loop, Ozark, AR 72949-2488 | 2019-11-04 |
| 1215586797 | Achor Management Inc | General Practice | 1900 Club Manor Dr Ste 101a, Maumelle, AR 72113-7443 | 2019-09-08 |
| 1093364820 | Center for Regenerative Medicine Pa | General Practice | 9307 Maumelle Blvd, North Little Rock, AR 72113-6609 | 2019-09-04 |
| 1083269690 | University of Arkansas At Monticello | General Practice | 663 University Drive, Monticello, AR 71656 | 2019-08-09 |
| 1912492786 | Chelsea Brown | General Practice | 6309 Highway 5 N, Bryant, AR 72022-8506 | 2018-06-25 |
| 1205345154 | Lakeside Walk-in Clinic Pllc | General Practice | 2230 Malvern Ave Ste E, Hot Springs, AR 71901-8000 | 2017-09-22 |
| 1558897595 | Epoch-nwa Pllc | General Practice | 5100 W Pauline Whitaker Pkwy, Ste. 110, Rogers, AR 72758-8335 | 2017-05-11 |
| 1023540655 | Aaron M Smith | General Practice | Varner Unit State Hwy 388, Gould, AR 71643 | 2017-04-02 |
| 1942749148 | Reece Lewis Crow | General Practice | 34 Windsor Road, Little Rock, AR 72212 | 2017-02-21 |
| Find all providers with the same taxonomy | ||||
| City | RUSSELLVILLE |
| Zip Code | 72801 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.