Provider Demographics
NPI:1114950433
Name:SALINE PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:SALINE PHYSICIAN SERVICES, LLC
Other - Org Name:SALINE MEMORIAL HOSPITALIST GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TITSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-6093
Mailing Address - Street 1:PO BOX 1635
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1635
Mailing Address - Country:US
Mailing Address - Phone:501-776-6252
Mailing Address - Fax:501-776-6271
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3353
Practice Address - Country:US
Practice Address - Phone:501-776-7130
Practice Address - Fax:501-776-6695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE COUNTY MEDICAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158019002Medicaid
AR5F357OtherBCBS
5G876Medicare PIN