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General NPI Number Information
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NPI Number | 1134141682
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Entity Type | Organization
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Legal Business Name | HOT SPRINGS PEDIATRIC CLINIC,P.A.
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 1920 MALVERN AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7752
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Country | US
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Telephone | 501-321-1314
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Fax | 501-321-1810
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Provider Business Mailing Address
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Address Line | 1920 MALVERN AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7752
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Country | US
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Telephone | 501-321-1314
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Fax | 510-321-1810
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANA MARIE MARTIN
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Credential | M.D.
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Telephone | 501-321-1314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | A02978
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-2525
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-3838
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-4451
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-7142
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License Number State | AR
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Taxonomy #6
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | A02978ANP
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License Number State | AR
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Taxonomy #7
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R-4078
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License Number State | AR
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