Provider Demographics
NPI:1215479159
Name:OUACHITA PHYSICIAN SERVICES, LLC
Entity type:Organization
Organization Name:OUACHITA PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-836-1200
Mailing Address - Street 1:415 HOSPITAL DR
Mailing Address - Street 2:STE. 3
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 HOSPITAL DR
Practice Address - Street 2:STE. 3
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4615
Practice Address - Country:US
Practice Address - Phone:870-836-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty