1841530318 NPI number — SOUTH CENTRAL MEDICAL SERVICES PA

Table of content: (NPI 1841530318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841530318 NPI number — SOUTH CENTRAL MEDICAL SERVICES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL MEDICAL SERVICES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841530318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 S 21ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72901-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-551-3556
Provider Business Mailing Address Fax Number:
800-861-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5212 VILLAGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-8104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-657-6888
Provider Business Practice Location Address Fax Number:
479-434-5572
Provider Enumeration Date:
02/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
CHESTER
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-551-3556

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: MC-2949 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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