=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972897056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOT SPRINGS AIDS RESOURCE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2011
-----------------------------------------------------
Last Update Date | 09/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 CENTRAL AVE SUITE A
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-623-5598
-----------------------------------------------------
Fax | 501-623-5516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 CENTRAL AVE SUITE A
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-623-5598
-----------------------------------------------------
Fax | 501-623-5516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MR. MIKE MELANCON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-623-5598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------