MEDICARE: THE DERMATOLOGY CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720611635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DERMATOLOGY CLINIC PA

Provider Business Mailing Address
First Line	:	3633 CENTRAL AVE STE N
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6475
Country	:	US
Telephone Number	:	501-623-6100
Fax Number	:	501-623-3403

Provider Business Practice Location Address
First Line	:	1710 MALVERN AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7132
Country	:	US
Telephone Number	:	501-623-6100
Fax Number	:	501-623-3403

Authorized Official
Title or Position	:	OWNER/ PROVIDER/ PHYSICIAN
Name	:	MR. ADAM S STIBICH
Credential	:	MD
Telephone Number	:	501-623-6100

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	09/08/2021

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Directions to “THE DERMATOLOGY CLINIC PA ” Practice Location

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