Provider Demographics
NPI:1386698959
Name:SURGICAL CLINIC, PA
Entity type:Organization
Organization Name:SURGICAL CLINIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-227-9080
Mailing Address - Street 1:9500 KANIS RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6324
Mailing Address - Country:US
Mailing Address - Phone:501-227-9080
Mailing Address - Fax:501-227-0410
Practice Address - Street 1:9500 KANIS RD
Practice Address - Street 2:SUITE 501
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6324
Practice Address - Country:US
Practice Address - Phone:501-227-9080
Practice Address - Fax:501-227-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104587002Medicare ID - Type Unspecified
AR57032Medicare ID - Type Unspecified