Healthcare Provider Details

I. General information

NPI: 1538336631
Provider Name (Legal Business Name): RONALD HURD CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN ST SUITE V
HOT SPRINGS AR
71913-4905
US

IV. Provider business mailing address

5706 SPRINGSIDE AVE
BRYANT AR
72022-9210
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-8200
  • Fax: 501-620-7874
Mailing address:
  • Phone: 501-545-7171
  • Fax: 501-620-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: