=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396818902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHFIRST PHYSICIANS OF ARKANSAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 09/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1662 HIGDON FERRY RD SUITE 200
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-623-2781
-----------------------------------------------------
Fax | 501-623-1774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1662 HIGDON FERRY RD SUITE 200
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-623-2781
-----------------------------------------------------
Fax | 501-623-1774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MARGARET BODEMANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-623-2781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MC1988
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------