OrganizationCatholic Health Initiatives -St. Vincent Interfaith Clinic, IncDentistDental ProvidersPractice Address830 N Creek Dr, Conway, AR 72032-4711(501) 932-0559PECOS EnrollmentBased on the most recent information from CMS, provider Catholic Health Initiatives -St. Vincent Interfaith Clinic, Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1881612703Provider TypeOrganizationFull NameCatholic Health Initiatives -St. Vincent Interfaith Clinic, IncSubpartNoEnumeration Date7/18/2006Last Updated6/15/2015Contact InformationPractice LocationPractice Address830 N Creek Dr, Conway, AR 72032-4711Phone(501) 932-0559Fax(501) 932-0227Mailing LocationMailing Address830 N Creek Dr, Conway, AR 72032-4711Phone(501) 932-0559Fax(501) 932-0227Authorized OfficialNameAaron, Kittie A (Executive Director)Phone(501) 932-0559Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicenseUnlisted IssuerCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1510001631DescriptionMedicaidIssuerUnlistedArkansas