Provider Demographics
NPI:1285660506
Name:HOT SPRINGS CLINIC OF OTOLARYNGOLOGY PA
Entity Type:Organization
Organization Name:HOT SPRINGS CLINIC OF OTOLARYNGOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-624-5422
Mailing Address - Street 1:307 CARPENTER DAM RD STE N
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8282
Mailing Address - Country:US
Mailing Address - Phone:501-624-5422
Mailing Address - Fax:501-624-4602
Practice Address - Street 1:307 CARPENTER DAM RD STE N
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8282
Practice Address - Country:US
Practice Address - Phone:501-624-5422
Practice Address - Fax:501-624-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102340002Medicaid
AR56798Medicare ID - Type Unspecified