Provider Demographics
NPI:1164950721
Name:SARAHROSE S. WEBSTER, M.D., P.A.
Entity Type:Organization
Organization Name:SARAHROSE S. WEBSTER, M.D., P.A.
Other - Org Name:WEBSTER SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCARLET
Authorized Official - Middle Name:
Authorized Official - Last Name:BITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-534-6400
Mailing Address - Street 1:1801 W 40TH AVE STE 4C
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6961
Mailing Address - Country:US
Mailing Address - Phone:870-534-6400
Mailing Address - Fax:870-534-3441
Practice Address - Street 1:1801 W 40TH AVE STE 4C
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6961
Practice Address - Country:US
Practice Address - Phone:870-534-6400
Practice Address - Fax:870-534-3441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAHROSE S. WEBSTER, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE9384208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR211512001Medicaid