| Hollywood Avenue Family Clinic | |
|
124 Hollywood Ave Hot Springs AR 71901-7057 | |
| (501) 624-0070 | |
| (501) 624-8721 |
| Full Name | Hollywood Avenue Family Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 124 Hollywood Ave, Hot Springs, Arkansas |
| Authorized Official Name and Position | Monica Bowman (PRESIDENT) |
| Authorized Official Contact | 6159207000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hollywood Avenue Family Clinic Po Box 4811 Belfast ME 04915-4811 Ph: (501) 624-0070 | Hollywood Avenue Family Clinic 124 Hollywood Ave Hot Springs AR 71901-7057 Ph: (501) 624-0070 |
| NPI Number | 1508162496 |
|---|---|
| Provider Enumeration Date | 02/10/2011 |
| Last Update Date | 02/09/2023 |
| Medicare PECOS PAC ID | 7012191406 |
|---|---|
| Medicare Enrollment ID | O20110408000467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508162496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MC1391 (Arkansas) | Primary |
| Provider Name | James Delbert Humphreys |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366403560 PECOS PAC ID: 7214902691 Enrollment ID: I20040914001211 |
| Provider Name | Ted M Faro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184621294 PECOS PAC ID: 5294790226 Enrollment ID: I20150112000941 |
| Provider Name | A Michele Maxwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669937488 PECOS PAC ID: 4082940358 Enrollment ID: I20190724001255 |
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