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General NPI Number Information
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NPI Number | 1205557204
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Entity Type | Organization
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Legal Business Name | HOURGLASS AESTHETICS MEDICAL SPA
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 1100 S MAIN ST
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City | HOPE
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State | AR
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Zip | 71801-7237
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Country | US
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Telephone | 870-770-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 S MAIN ST
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City | HOPE
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State | AR
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Zip | 71801-7237
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Country | US
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Telephone | 870-770-4467
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Fax |
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Authorized Official
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Title or Position | COO/CFO
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Name | JODIE POOLE
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Credential |
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Telephone | 870-703-7975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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