Provider Demographics
NPI:1558678276
Name:SALINE PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:SALINE PHYSICIAN SERVICES, LLC
Other - Org Name:SALINE SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PHYSICIAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
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 1:5 MEDICAL PARK DR
Mailing Address - Street 2:SUITE GL2
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3729
Mailing Address - Country:US
Mailing Address - Phone:501-778-4862
Mailing Address - Fax:501-778-4685
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE GL2
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-778-4862
Practice Address - Fax:501-778-4685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE COUNTY MEDICAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-01
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1558678276OtherBCBS
AR1558678276OtherBCBS