Provider Demographics
NPI:1093825002
Name:SALINE ORTHOPEDIC GROUP P A
Entity Type:Organization
Organization Name:SALINE ORTHOPEDIC GROUP P A
Other - Org Name:ARKANSAS BONE & JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-315-0984
Mailing Address - Street 1:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-3250
Mailing Address - Country:US
Mailing Address - Phone:501-315-0984
Mailing Address - Fax:501-847-1405
Practice Address - Street 1:2010 ACTIVE WAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72022-9267
Practice Address - Country:US
Practice Address - Phone:501-315-0984
Practice Address - Fax:501-847-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105470002Medicaid
AR0486420001Medicare NSC
AR105470002Medicaid