Provider Demographics
NPI:1568599892
Name:SOUTH ARKANSAS ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SOUTH ARKANSAS ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CCP
Authorized Official - Phone:501-227-0700
Mailing Address - Street 1:PO BOX 55990
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-5990
Mailing Address - Country:US
Mailing Address - Phone:501-227-0700
Mailing Address - Fax:501-227-0744
Practice Address - Street 1:2704 VINE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:501-227-0700
Practice Address - Fax:501-227-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR48530367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty