Basic Information
| Provider Information | |||||||||
| NPI: | 1396818902 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHFIRST PHYSICIANS OF ARKANSAS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DBA HOT SPRINGS INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1662 HIGDON FERRY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016232781 | ||||||||
| FaxNumber: | 5016231774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1662 HIGDON FERRY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016232781 | ||||||||
| FaxNumber: | 5016231774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 09/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | BODEMANN | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5016232781 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MC1988 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 131307002 | 05 | AR | MEDICAID |