Provider Demographics
NPI:1174609713
Name:FIRST IN SERVICE HOSPITALISTS, PA
Entity type:Organization
Organization Name:FIRST IN SERVICE HOSPITALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-424-7070
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-1269
Mailing Address - Country:US
Mailing Address - Phone:870-425-6322
Mailing Address - Fax:870-424-5859
Practice Address - Street 1:624 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2955
Practice Address - Country:US
Practice Address - Phone:870-425-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-3117208M00000X
AR208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229343002Medicaid
AR5C682Medicare PIN