Healthcare Provider Details

I. General information

NPI: 1942277454
Provider Name (Legal Business Name): HOT SPRINGS HEALTH PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL PARK DR
MARSHALL NC
28753-6807
US

IV. Provider business mailing address

PO BOX 69
MARSHALL NC
28753-0069
US

V. Phone/Fax

Practice location:
  • Phone: 828-649-3500
  • Fax: 828-649-1032
Mailing address:
  • Phone: 828-649-0800
  • Fax: 828-649-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA B STROM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-649-0800