Provider Demographics
NPI:1598978801
Name:SOUTH AR SURGICAL CLINIC OF EL DORADO, INC
Entity Type:Organization
Organization Name:SOUTH AR SURGICAL CLINIC OF EL DORADO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-862-3411
Mailing Address - Street 1:815 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4464
Mailing Address - Country:US
Mailing Address - Phone:870-862-3411
Mailing Address - Fax:
Practice Address - Street 1:815 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4464
Practice Address - Country:US
Practice Address - Phone:870-862-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty