Provider Demographics
NPI:1962447680
Name:WADE, BILLY KOSSUTH (MD)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:KOSSUTH
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29001
Mailing Address - Street 2:STE 900
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-9001
Mailing Address - Country:US
Mailing Address - Phone:501-622-1043
Mailing Address - Fax:501-622-2033
Practice Address - Street 1:300 WERNER ST.
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-622-1043
Practice Address - Fax:501-622-2033
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5942207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
554306972OtherMEDICARE LINKED
OK100079170AMedicaid
TX115829701Medicaid
TX190656201Medicaid
AK103425001Medicaid
D75038Medicare UPIN
TX190656201Medicaid
TX8F6410Medicare PIN