Provider Demographics
NPI:1598794257
Name:SOUTH ARKANSAS GASTROENTEROLOGY CLINIC
Entity Type:Organization
Organization Name:SOUTH ARKANSAS GASTROENTEROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUTLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-536-7660
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6940
Mailing Address - Country:US
Mailing Address - Phone:870-536-7660
Mailing Address - Fax:870-536-6750
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 5A
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6940
Practice Address - Country:US
Practice Address - Phone:870-536-7660
Practice Address - Fax:870-536-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B528Medicare ID - Type Unspecified