Healthcare Provider Details

I. General information

NPI: 1699933564
Provider Name (Legal Business Name): HOT SPRINGS HEALTH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/08/2010
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: 828-649-3944
Mailing address:
  • Phone: 828-649-0800
  • Fax: 828-649-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number03008
License Number StateNC

VIII. Authorized Official

Name: PAUL DEMPSEY
Title or Position: DIR OF PHCY
Credential: PHARMD
Phone: 828-649-0800