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 yesterday at 11:47 AM.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