1740368877 NPI number — HEALTHSTAR PHYSICIANS OF HOT SPRINGS

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 1740368877 NPI number — HEALTHSTAR PHYSICIANS OF HOT SPRINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHSTAR PHYSICIANS OF HOT SPRINGS
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:
6
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:
1740368877
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:
248 HIGHWAY 70 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71943-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-356-4801
Provider Business Practice Location Address Fax Number:
870-356-5357
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTHERLAND
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LARIE
Authorized Official Title or Position:
OFFICE MANAGER
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: 139988002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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