Provider Demographics
NPI:1295736825
Name:PLASTIC AND RECONSTRUCTIVE SURGERY ASSOCIATES
Entity type:Organization
Organization Name:PLASTIC AND RECONSTRUCTIVE SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-663-4100
Mailing Address - Street 1:11300 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4153
Mailing Address - Country:US
Mailing Address - Phone:501-663-4100
Mailing Address - Fax:501-663-4145
Practice Address - Street 1:11300 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4153
Practice Address - Country:US
Practice Address - Phone:501-663-4100
Practice Address - Fax:501-663-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104999002Medicaid
AR104999002Medicaid
AR57282Medicare PIN