1568082840 NPI number — HOT SPRINGS HEART AND VASCULAR CORP

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 1568082840 NPI number — HOT SPRINGS HEART AND VASCULAR CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOT SPRINGS HEART AND VASCULAR CORP
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:
Provider Other Organization Name Type Code:
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:
1568082840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 LONG ISLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-9636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-622-7691
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CRACKER BOX LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS NATIONAL PARK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-767-4278
Provider Business Practice Location Address Fax Number:
501-767-4328
Provider Enumeration Date:
04/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TAUTH
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-622-7691

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1C0710 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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