Provider Demographics
NPI:1760631121
Name:MCSA LLC
Entity Type:Organization
Organization Name:MCSA LLC
Other - Org Name:MEDICAL CENTER OF SOUTH ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR /DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:700 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4416
Mailing Address - Country:US
Mailing Address - Phone:870-863-2000
Mailing Address - Fax:870-863-5442
Practice Address - Street 1:700 W GROVE 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:870-863-2000
Practice Address - Fax:870-863-5442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCSA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-10
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3537275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04U088Medicare Oscar/Certification