Basic Information
| Provider Information | |||||||||
| NPI: | 1770512857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAXTON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ZIEGELMEIER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013212229 | ||||||||
| FaxNumber: | 5013212342 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 WOMEN'S CENTER LANE | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016092229 | ||||||||
| FaxNumber: | 5016092342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | E6147 | AR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 178690001 | 05 | AR | MEDICAID |