Provider Demographics
NPI:1508159708
Name:HUNT, BASIL TODD
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:TODD
Last Name:HUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 LONE OAK DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-8535
Mailing Address - Country:US
Mailing Address - Phone:870-741-8881
Mailing Address - Fax:
Practice Address - Street 1:724 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2913
Practice Address - Country:US
Practice Address - Phone:866-308-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator