Provider Demographics
NPI:1730194556
Name:HOT SPRINGS RADIATION ONCOLOGY, PA
Entity type:Organization
Organization Name:HOT SPRINGS RADIATION ONCOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-622-1913
Mailing Address - Street 1:PO BOX 22148
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-2148
Mailing Address - Country:US
Mailing Address - Phone:501-622-1913
Mailing Address - Fax:601-622-4676
Practice Address - Street 1:1455 HIGDON FERRY RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6419
Practice Address - Country:US
Practice Address - Phone:501-622-2100
Practice Address - Fax:501-622-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145636002Medicaid