Healthcare Provider Details

I. General information

NPI: 1972897056
Provider Name (Legal Business Name): HOT SPRINGS AIDS RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CENTRAL AVE SUITE A
HOT SPRINGS AR
71901-6848
US

IV. Provider business mailing address

1801 CENTRAL AVE SUITE A
HOT SPRINGS AR
71901-6848
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-5598
  • Fax: 501-623-5516
Mailing address:
  • Phone: 501-623-5598
  • Fax: 501-623-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE MELANCON
Title or Position: BILLING MANAGER
Credential:
Phone: 501-623-5598