NPIMap

Organization Active NPI

St. Mary - Rogers Memorial Hospital Dba Friends House

  • Respite Care
  • Rogers, AR
National Provider Identifier
1174588784
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
040 Issued in AR
Legal business name
ST. MARY - ROGERS MEMORIAL HOSPITAL DBA FRIENDS HOUSE
Practice address
1200 W Walnut St
Rogers, AR 72756-3546
Phone
(479) 636-0200
Fax
(479) 986-3469
NPI assigned
Apr 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kenneth C Robinson
Title
Chief Financial Officer
Phone
(479) 936-2843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X 040 AR Primary

Addresses

Primary practice location

1200 W Walnut St
Rogers, AR 72756-3546

Mailing address

1200 W Walnut St
Rogers, AR 72756-3546
Phone (479) 636-0200

Other identifiers 4

IdentifierTypeStateIssuer
95007597MedicaidCO
1765261MedicaidLA
0866460MedicaidOH
0987149MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Jeff M Audibert6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174588784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W WALNUT ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727563546",
            "telephone_number": "479-636-0200",
            "fax_number": "479-986-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W WALNUT ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727563546",
            "telephone_number": "479-636-0200",
            "fax_number": "479-986-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY - ROGERS MEMORIAL HOSPITAL DBA FRIENDS HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "479-936-2843",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "AR",
            "license": "040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95007597",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1765261",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0866460",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0987149",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.