Provider Demographics
NPI:1902157951
Name:ST VINCENT MEDICAL GROUP
Entity Type:Organization
Organization Name:ST VINCENT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-1690
Mailing Address - Street 1:10 VIEW POINT CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1711
Mailing Address - Country:US
Mailing Address - Phone:501-588-3910
Mailing Address - Fax:
Practice Address - Street 1:10 VIEW POINT CV
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1711
Practice Address - Country:US
Practice Address - Phone:501-588-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-29
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty