ST MARY'S PHYSICIAN SERVICES LLC
NPI 1124084991
General Practice in Russellville, AR

Q: What is St Mary's Physician Services LLC's NPI number?

The NPI number for St Mary's Physician Services LLC is 1124084991. It was assigned to this organization in the NPPES registry on April 21, 2006.

Q: What is St Mary's Physician Services LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since April 21, 2006

101 SKYLINE DR, RUSSELLVILLE, AR 72801(479) 968-2345(479) 890-2497 Get Directions Write a Review

NPPES record last updated: September 26, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 26, 2024, Feb 7, 2023, Jun 16, 2019 (3 updates tracked since 2019).

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About St Mary's Physician Services Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST MARY'S PHYSICIAN SERVICES LLC (NPI 1124084991) is a healthcare organization registered as a general practice in Russellville, Arkansas and active in the NPI registry since April 2006. The organization lists Charlotte Lawrence, Secretary, as its authorized official.

NPPES Registry Identity

NPI1124084991

Entity TypeOrganization

Primary Taxonomy208D00000X

Legal Business NameST MARY'S PHYSICIAN SERVICES LLC

Location Address101 SKYLINE DRRussellville, AR 72801-3363

Mailing Address101 Skyline DrRussellville, AR 72801-3363 · (479) 968-2345

Phone(479) 968-2345

Fax(479) 890-2497

Organization SubpartNo

Authorized OfficialCharlotte LawrenceSecretary · (615) 920-7000

Enumeration DateApril 21, 2006

Last NPPES UpdateSeptember 26, 20243 updates tracked since enumeration

NPPES CertifiedSeptember 26, 2024

✔ NPI 1124084991 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedInternal MedicineTaxonomy 207R00000X

101 SKYLINE DR, Russellville, AR 72801

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Other Identifiers 2

OtherDA8026Railroad Medicare Ptan

Medicaid152955002AR

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARK EDWARD BUCHANAN M.D.

Orthopaedic Surgery