Provider Demographics
NPI:1134141682
Name:HOT SPRINGS PEDIATRIC CLINIC,P.A.
Entity Type:Organization
Organization Name:HOT SPRINGS PEDIATRIC CLINIC,P.A.
Other - Org Name:HOT SPRINGS PEDIATRIC CLINIC, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-321-1314
Mailing Address - Street 1:1920 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7752
Mailing Address - Country:US
Mailing Address - Phone:501-321-1314
Mailing Address - Fax:510-321-1810
Practice Address - Street 1:1920 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7752
Practice Address - Country:US
Practice Address - Phone:501-321-1314
Practice Address - Fax:501-321-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4078208000000X
ARE-2525208000000X
ARE-3838208000000X
ARE-4451208000000X
ARE-7142208000000X
ARA02978ANP363LP0200X
ARA02978363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1134141682Medicaid