Devan Medical

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DEVAN MEDICAL

Doing business as

West Gate Walk-In Clinic

Practice address

140 Cordoba Center Dr
Hot Springs Village, AR 71909-4020

Phone

(501) 520-7503

NPI assigned

Dec 23, 2020

Last updated

Dec 29, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jarrod Devan Breshears, APN

Title

Owner

Phone

(501) 520-7503

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• West Gate Walk-In Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1669069613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 CORDOBA CENTER DR",
            "city": "HOT SPRINGS VILLAGE",
            "state": "AR",
            "postal_code": "719094020",
            "telephone_number": "501-520-7503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 CORDOBA CENTER DR",
            "city": "HOT SPRINGS VILLAGE",
            "state": "AR",
            "postal_code": "719094020",
            "telephone_number": "501-520-7503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVAN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "BRESHEARS",
        "authorized_official_first_name": "JARROD",
        "authorized_official_middle_name": "DEVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-520-7503",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213822758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Gate Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Hot Springs Village, AR
• Providers in Hot Springs Village, AR by specialty
• Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.