Basic Information
| Provider Information | |||||||||
| NPI: | 1609845346 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OUACHITA REGIONAL DIAGNOSTIC AND SURGERY CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEALTHPARK HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1636 HIGDON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015202000 | ||||||||
| FaxNumber: | 5015203736 | ||||||||
| Practice Location | |||||||||
| Address1: | 1636 HIGDON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015202000 | ||||||||
| FaxNumber: | 5015203736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | SPRING | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5015202000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | AR4180 | AR | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 10142 | 01 | AR | AR BLUE CROSS BLUE SHIELD | OTHER |