Provider Demographics
NPI:1548722028
Name:STEPHEN L BODEMANN M.D. LTD
Entity type:Organization
Organization Name:STEPHEN L BODEMANN M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BODEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-520-7731
Mailing Address - Street 1:229 FOREST HEIGHTS TR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-262-1041
Mailing Address - Fax:501-651-2384
Practice Address - Street 1:1636 HIGDON FERRY ROAD
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:501-651-2000
Practice Address - Fax:501-651-2391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN L BODEMANN M.D. LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102441001Medicaid