MEDICARE: HEALTHSTAR PHYSICIANS OF HOT SPRINGS, PLLC

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
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG9647	OTHER	AR	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1376884692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSTAR PHYSICIANS OF HOT SPRINGS, PLLC

Provider Business Mailing Address
First Line	:	1661 AIRPORT RD
Second Line	:	SUITE D
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-7951
Country	:	US
Telephone Number	:	501-625-7500
Fax Number	:	501-625-7777

Provider Business Practice Location Address
First Line	:	1661 AIRPORT RD STE F
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-8184
Country	:	US
Telephone Number	:	501-651-4300
Fax Number	:	501-651-4318

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MS. BRENDA LARIE SOUTHERLAND
Credential	:
Telephone Number	:	501-625-7500

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	04/03/2018

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