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General NPI Number Information
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NPI Number | 1649323213
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Entity Type | Organization
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Legal Business Name | PHYSICIAN MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 295 SECTION LINE RD STE B
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6433
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Country | US
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Telephone | 501-623-6161
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Fax | 501-520-4881
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Provider Business Mailing Address
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Address Line | PO BOX 22861
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City | HOT SPRINGS
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State | AR
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Zip | 71903-2861
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Country | US
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Telephone | 501-623-6161
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Fax | 501-520-4881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRISCILLA LIZELLE HERNANDO TANGUNAN
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Credential | M.D.
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Telephone | 501-623-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C-8539
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License Number State | AR
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