NPIMap

Organization Active NPI

St Marys Physician Services LLC

Doing business as Millard-Henry Clinic of Russellville

  • Rural Health Clinic/Center
  • Russellville, AR
National Provider Identifier
1396637682
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST MARYS PHYSICIAN SERVICES LLC
Doing business as
Millard-Henry Clinic of Russellville
Practice address
101 Skyline Dr Ste a
Russellville, AR 72801-3363
Phone
(479) 968-2345
Fax
(479) 890-2497
NPI assigned
Jul 19, 2025
Last updated
Jan 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

101 Skyline Dr Ste a
Russellville, AR 72801-3363

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names 1

  • Millard-Henry Clinic of Russellville Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0468990Millard Henry Clinic101 Skyline Dr, Russellville, AR 72801ComplianceMay 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
St Marys Physician Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

101 Skyline Dr
Ste A
Russellville, AR 72801
Phone (479) 968-2345

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1752883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768176000000",
    "number": "1396637682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SKYLINE DR STE A",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013363",
            "telephone_number": "479-968-2345",
            "fax_number": "479-890-2497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARYS PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-19",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Millard-Henry Clinic of Russellville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.