NPIMap

Organization Active NPI

St Vincent Medical Group

  • Dentist
  • Little Rock, AR
National Provider Identifier
1861786774
Registry record updated Jun 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ST VINCENT MEDICAL GROUP
Practice address
2500 E 6TH St
Little Rock, AR 72202-3008
Phone
(501) 552-4710
Fax
(501) 376-2084
NPI assigned
Jun 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2011

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

Authorized official

Name
Mrs. Lavaleria Jane Smith
Title
Clinic Manager
Phone
(501) 552-4710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2500 E 6TH St
Little Rock, AR 72202-3008

Mailing address

2500 E 6TH St
Little Rock, AR 72202-3008
Phone (501) 552-4710

Other names 1

  • St Vincent Health Clinic East 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
04D0466915St Vincent Health Clinic East2500 E 6TH Street, Little Rock, AR 72202Certificate of waiverFeb 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
St Vincent Medical Grou6 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.

Locations

2500 E 6th St
Little Rock, AR 72202
Phone (501) 376-2007

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1861786774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 E 6TH ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023008",
            "telephone_number": "501-552-4710",
            "fax_number": "501-376-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E 6TH ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023008",
            "telephone_number": "501-552-4710",
            "fax_number": "501-376-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-08",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LAVALERIA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "501-552-4710",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Vincent Health Clinic East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.