Basic Information
| Provider Information | |||||||||
| NPI: | 1669464079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERITAGE PHYSICIAN GROUP | ||||||||
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| OtherOrganizationName: | HOT SPRINGS MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016271800 | ||||||||
| FaxNumber: | 5016271899 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MERCY LN | ||||||||
| Address2: | STE 201 | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013212229 | ||||||||
| FaxNumber: | 5013214056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 09/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | BRASHEAR | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5013212229 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.