1497168397 NPI number — SOUTH CENTRAL MEDICAL SERVICES, P.A.

Table of content: (NPI 1497168397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497168397 NPI number — SOUTH CENTRAL MEDICAL SERVICES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL MEDICAL SERVICES, P.A.
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:
1497168397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11020
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:
72917-1020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-434-4887
Provider Business Mailing Address Fax Number:
479-434-4955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 AUTUMN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72211-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-448-2342
Provider Business Practice Location Address Fax Number:
501-221-0615
Provider Enumeration Date:
06/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
CHESTER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
479-657-6888

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  E5307 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com