1316279375 NPI number — HEALTHSTAR PHYSICIANS OF HOT SPRINGS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316279375 NPI number — HEALTHSTAR PHYSICIANS OF HOT SPRINGS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHSTAR PHYSICIANS OF HOT SPRINGS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOUNTAIN LAKE FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316279375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1661 AIRPORT RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-7951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-625-7500
Provider Business Mailing Address Fax Number:
501-625-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4517 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-9476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-623-7900
Provider Business Practice Location Address Fax Number:
501-623-7337
Provider Enumeration Date:
02/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FINCH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
501-625-7500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DS0108 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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