Provider Demographics
NPI:1407845951
Name:SOUTH ARKANSAS ORTHOPAEDICS AND SPORTS MEDICINE CENTER PLLC
Entity Type:Organization
Organization Name:SOUTH ARKANSAS ORTHOPAEDICS AND SPORTS MEDICINE CENTER PLLC
Other - Org Name:SOUTH ARKANSAS ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-862-1144
Mailing Address - Street 1:PO BOX 10730
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-0028
Mailing Address - Country:US
Mailing Address - Phone:870-862-1144
Mailing Address - Fax:870-864-0782
Practice Address - Street 1:2700 VINE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6700
Practice Address - Country:US
Practice Address - Phone:870-862-1144
Practice Address - Fax:870-864-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200039405OtherUNITED/RAILROAD MEDICARE
AR200039406OtherUNITED/RAILROAD MEDICARE
AR200031980OtherUNITED/RAILROAD MEDICARE
AR141689002Medicaid
AR141689002Medicaid
AR200039405OtherUNITED/RAILROAD MEDICARE