Provider Demographics
NPI:1912012337
Name:SOUTHERN CARE INC
Entity Type:Organization
Organization Name:SOUTHERN CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:B
Authorized Official - Middle Name:PAM
Authorized Official - Last Name:PADGET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-589-2206
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-0088
Mailing Address - Country:US
Mailing Address - Phone:870-589-2206
Mailing Address - Fax:870-589-2206
Practice Address - Street 1:669 N FALLS BLV
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396
Practice Address - Country:US
Practice Address - Phone:870-589-2206
Practice Address - Fax:870-589-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47360Medicare ID - Type Unspecified