MEDICARE: VIRGILIO VILLEDA MD

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	207R00000X	Internal Medicine Physician	2014017892	MO
2	208M00000X	Hospitalist Physician	E-10059	AR

General Provider Information

NPI Number	:	1699189407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGILIO VILLEDA MD

Provider Business Mailing Address
First Line	:	PO BOX 21850
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71903-1850
Country	:	US
Telephone Number	:	501-609-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	ONE MERCY LANE SUITE 404
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-7637
Country	:	US
Telephone Number	:	501-609-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	07/21/2022

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