Provider Demographics
NPI:1467410027
Name:SURGICAL ASSOCIATES OF CROSSETT, PA
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF CROSSETT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-364-4013
Mailing Address - Street 1:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-1095
Mailing Address - Country:US
Mailing Address - Phone:870-364-4013
Mailing Address - Fax:870-364-4184
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-4013
Practice Address - Fax:870-364-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG03640Medicare UPIN
AR5K637Medicare ID - Type Unspecified