=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053424689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGESTIVE DISEASES CLINIC OF HOT SPRINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 12/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 MCGOWAN CT
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-625-7727
-----------------------------------------------------
Fax | 501-625-7730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 MCGOWAN CT
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-625-7727
-----------------------------------------------------
Fax | 501-625-7730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. JOHN OLIVER BRANDT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 501-625-7727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------