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NPI Code Detail

MEDICARE: HEALTHY CONNECTIONS SPECIALTY, LLC

MEDICARE: HEALTHY CONNECTIONS SPECIALTY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1366986168
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHY CONNECTIONS SPECIALTY, LLC
Provider Business Mailing Address
First Line : PO BOX 1848
Second Line :
City : MENA
State : AR
Zip : 71953-1841
Country : US
Telephone Number : 479-437-3449
Fax Number : 479-243-0285
Provider Business Practice Location Address
First Line : 1723 MALVERN AVE
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71901-7133
Country : US
Telephone Number : 501-620-4600
Fax Number : 501-620-4610
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : SHANA BUSH
Credential :
Telephone Number : 479-437-3449
Provider Enumeration Date : 12/13/2016
Last Update Date : 05/13/2020

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Directions to “HEALTHY CONNECTIONS SPECIALTY, LLC ” Practice Location

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