Healthcare Provider Details

I. General information

NPI: 1326641606
Provider Name (Legal Business Name): HCC OF WARREN HOSPITALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S BRADLEY ST
WARREN AR
71671-3459
US

IV. Provider business mailing address

17304 PRESTON RD STE 1400
DALLAS TX
75252-5633
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-3731
  • Fax:
Mailing address:
  • Phone: 870-226-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RON WEISS
Title or Position: CEO
Credential:
Phone: 866-931-8882