Basic Information
| Provider Information | |||||||||
| NPI: | 1316497464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL CARE CONSULTANTS OF FORDYCE LLC | ||||||||
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| OtherOrganizationName: | HCC OF FORDYCE, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 N CLIFTON ST | ||||||||
| Address2: | |||||||||
| City: | FORDYCE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717423026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703526300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2016 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8669318882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.