St Mary's Physician Services LLC
NPI 1124084991ActiveOrganization· General Practice· Russellville, AR
General Practice in Russellville, Arkansas, registered in NPPES in April 2006. The authorized official on file is Charlotte Lawrence, Secretary. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1124084991 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 21, 2006 |
| Last updated in NPPES | Sep 26, 2024 |
| Certified by provider | Sep 26, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
| Internal Medicine | 207R00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (AR) |
|---|
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