Healthcare Provider Details

I. General information

NPI: 1821064593
Provider Name (Legal Business Name): HOT SPRINGS PULMONARY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 MERCY LANE STE 401
HOT SPRINGS AR
71913
US

IV. Provider business mailing address

#1 MERCY LANE STE 401
HOT SPRINGS AR
71913
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-5220
  • Fax: 501-623-1546
Mailing address:
  • Phone: 501-623-5220
  • Fax: 501-623-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMO1066
License Number StateAR

VIII. Authorized Official

Name: MRS. SHIRLEY M GREEN
Title or Position: ASST OFF MGR
Credential:
Phone: 501-623-5220