1750835096 NPI number — MRS. LOIA CLOUD BONDHUS HOT SPRINGS

Table of content: MRS. LOIA CLOUD BONDHUS HOT SPRINGS (NPI 1750835096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750835096 NPI number — MRS. LOIA CLOUD BONDHUS HOT SPRINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONDHUS
Provider First Name:
LOIA
Provider Middle Name:
CLOUD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HOT SPRINGS
Provider Gender Code:
F

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:
1750835096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10025 WEST MARKHAM ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-663-5473
Provider Business Mailing Address Fax Number:
501-801-1816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3604 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-623-9220
Provider Business Practice Location Address Fax Number:
501-623-9227
Provider Enumeration Date:
08/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  7923-M , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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