Provider Demographics
NPI:1467510255
Name:HEALTHFIRST PHYSICIANS OF ARKANSAS, PA
Entity Type:Organization
Organization Name:HEALTHFIRST PHYSICIANS OF ARKANSAS, PA
Other - Org Name:VILLAGE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-623-2781
Mailing Address - Street 1:4419 N HIGHWAY 7
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9301
Mailing Address - Country:US
Mailing Address - Phone:501-922-2217
Mailing Address - Fax:501-922-4216
Practice Address - Street 1:4419 N HIGHWAY 7
Practice Address - Street 2:SUITE 201
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-9301
Practice Address - Country:US
Practice Address - Phone:501-922-2217
Practice Address - Fax:501-922-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131127002Medicaid
57343Medicare PIN
ARCD4167Medicare PIN