Provider Demographics
NPI:1760429666
Name:OUACHITA SURGICAL SERVICES INC
Entity Type:Organization
Organization Name:OUACHITA SURGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TINNESZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-394-1414
Mailing Address - Street 1:400 CRESTWOOD CIR
Mailing Address - Street 2:SUITE P
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5512
Mailing Address - Country:US
Mailing Address - Phone:479-394-1414
Mailing Address - Fax:479-394-2612
Practice Address - Street 1:400 CRESTWOOD CIR
Practice Address - Street 2:SUITE P
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5512
Practice Address - Country:US
Practice Address - Phone:479-394-1414
Practice Address - Fax:479-394-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR020035810OtherRAILROAD MEDICARE
AR132816002Medicaid
OK100728320AMedicaid
AR50830OtherBLUE CROSS BLUE SHIELD
AR=========OtherNOVASYS
AR=========OtherCIGNA
AR=========OtherDELTA HEALTH SYSTEM
AR132816002Medicaid
AR=========OtherAETNA
AR132816002Medicaid
AR=========OtherDELTA HEALTH SYSTEM