Provider Demographics
NPI:1053424689
Name:DIGESTIVE DISEASES CLINIC OF HOT SPRINGS
Entity type:Organization
Organization Name:DIGESTIVE DISEASES CLINIC OF HOT SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-625-7727
Mailing Address - Street 1:151 MCGOWAN CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6451
Mailing Address - Country:US
Mailing Address - Phone:501-625-7727
Mailing Address - Fax:501-625-7730
Practice Address - Street 1:151 MCGOWAN CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6451
Practice Address - Country:US
Practice Address - Phone:501-625-7727
Practice Address - Fax:501-625-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C792Medicare ID - Type Unspecified