Provider Demographics
NPI:1649376260
Name:INDEPENDENCE HEALTHCARE INC
Entity type:Organization
Organization Name:INDEPENDENCE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-623-4422
Mailing Address - Street 1:1303 CENTRAL AVENUE
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:501-623-4422
Mailing Address - Fax:501-623-4424
Practice Address - Street 1:1303 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-623-4422
Practice Address - Fax:501-623-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49913OtherBCBS
AR154494716Medicaid
5153940001Medicare NSC