Provider Demographics
NPI:1306897574
Name:THE SURGICAL HOSPITAL OF JONESBORO
Entity type:Organization
Organization Name:THE SURGICAL HOSPITAL OF JONESBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-336-1100
Mailing Address - Street 1:909 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-9201
Mailing Address - Country:US
Mailing Address - Phone:870-336-1100
Mailing Address - Fax:870-336-1013
Practice Address - Street 1:909 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-9201
Practice Address - Country:US
Practice Address - Phone:870-336-1100
Practice Address - Fax:870-336-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4164282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F081OtherBCBS PART B PROVIDER #
AR10145OtherBCBS PART A
AR040145Medicare Oscar/Certification
AR5F081OtherBCBS PART B PROVIDER #