Healthcare Provider Details

I. General information

NPI: 1003883570
Provider Name (Legal Business Name): MISSION CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN SUITE 405
HOT SPRINGS AR
71913-6442
US

IV. Provider business mailing address

1 MERCY LN SUITE 405
HOT SPRINGS AR
71913-6442
US

V. Phone/Fax

Practice location:
  • Phone: 501-622-1939
  • Fax: 501-622-3993
Mailing address:
  • Phone: 501-622-1939
  • Fax: 501-622-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK LAREY
Title or Position: EXECUTIVE DIRECTOR
Credential: D.O.
Phone: 501-622-1085