Provider Demographics
NPI:1982931192
Name:NORTH ARKANSAS SURGERY CLINIC
Entity Type:Organization
Organization Name:NORTH ARKANSAS SURGERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:I
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-741-8343
Mailing Address - Street 1:715 W SHERMAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2743
Mailing Address - Country:US
Mailing Address - Phone:870-741-8343
Mailing Address - Fax:870-741-8356
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2743
Practice Address - Country:US
Practice Address - Phone:870-741-8343
Practice Address - Fax:870-741-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-8118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120084001Medicaid
AR120084001Medicaid