Organization
INDEPENDENCE HEALTHCARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK BRAZIEL (PRESIDENT)
(501) 623-4422
Entity
Organization
Contact information
Practice address
1303 CENTRAL AVENUE, HOT SPRINGS, AR 71901
(501) 623-4422
(501) 623-4424
Mailing address
1303 CENTRAL AVENUE, HOT SPRINGS, AR 71901
(501) 623-4422
(501) 623-4424
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154494716
—
AR
01
—
49913
BCBS
AR
Enumeration date
09/15/2006
Last updated
04/03/2013
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