Provider Demographics
NPI:1174741375
Name:HOT SPRINGS GASTROENTEROLOGY CLINIC
Entity type:Organization
Organization Name:HOT SPRINGS GASTROENTEROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-623-4898
Mailing Address - Street 1:1 MERCY LN STE 307
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6440
Mailing Address - Country:US
Mailing Address - Phone:501-623-4898
Mailing Address - Fax:501-623-0260
Practice Address - Street 1:1 MERCY LN STE 307
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6440
Practice Address - Country:US
Practice Address - Phone:501-623-4898
Practice Address - Fax:501-623-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-0581207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124964002Medicaid
AR124964002Medicaid