Provider Demographics
NPI:1508195645
Name:SALINE PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:SALINE PHYSICIAN SERVICES, LLC
Other - Org Name:SMH ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIM
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:501-771-4693
Mailing Address - Fax:501-771-4885
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:501-776-6381
Practice Address - Fax:501-776-6350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE PHYSICIAN SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-21
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181231002Medicaid
AR5G433Medicare PIN
AR181231002Medicaid