Provider Demographics
NPI:1528202223
Name:MONTICELLO SURGICAL ASSOCIATES,PA
Entity Type:Organization
Organization Name:MONTICELLO SURGICAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-367-3922
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657-0125
Mailing Address - Country:US
Mailing Address - Phone:870-367-3922
Mailing Address - Fax:870-367-6413
Practice Address - Street 1:750 HL ROSS DRIVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5705
Practice Address - Country:US
Practice Address - Phone:870-367-3922
Practice Address - Fax:870-367-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5311208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty