Healthcare Provider Details

I. General information

NPI: 1033701578
Provider Name (Legal Business Name): HEALTHSTAR PHYSICIANS PRACTICE MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-625-7500
  • Fax: 501-625-7777
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA SOUTHERLAND
Title or Position: CFO
Credential:
Phone: 501-625-7500