Provider Demographics
NPI:1568718633
Name:SALINE PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:SALINE PHYSICIAN SERVICES, LLC
Other - Org Name:SALINE MEMORIAL HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-6012
Mailing Address - Street 1:1 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE 305
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-776-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE COUNTY MEDICAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty