Healthcare Provider Details

I. General information

NPI: 1730532003
Provider Name (Legal Business Name): HEALTHSTAR PHYSICIANS OF HOT SPRINGS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ADCOCK ROAD SUITE D
HOT SPRINGS AR
71913-7958
US

IV. Provider business mailing address

1661 AIRPORT RD SUITE D
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 501-547-5691
  • Fax: 501-651-4296
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA LAURIE SOUTHERLAND
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 501-627-4451