Provider Demographics
NPI:1538197389
Name:ST BERNARDS HOSPITAL, INC.
Entity type:Organization
Organization Name:ST BERNARDS HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-4429
Mailing Address - Street 1:225 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3111
Mailing Address - Country:US
Mailing Address - Phone:870-207-4100
Mailing Address - Fax:870-974-5112
Practice Address - Street 1:1726 MARIE CIR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5355
Practice Address - Country:US
Practice Address - Phone:870-935-6310
Practice Address - Fax:870-931-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4055251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11512OtherBLUE CROSS
AR126604747Medicaid
AR126604747Medicaid