Basic Information
| Provider Information | |||||||||
| NPI: | 1053692137 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOT SPRING COUNTY MEDICAL SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MALVERN SURGICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 SCHNEIDER DR | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721044811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013321000 | ||||||||
| FaxNumber: | 5013327395 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 SCHNEIDER DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MALVERN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721044816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013321012 | ||||||||
| FaxNumber: | 5013327088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2011 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5013321004 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOT SPRING COUNTY MEDICAL SERVICES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.