Provider Demographics
NPI:1427337773
Name:SALINE PHYSICIAN SERVICES, LLC
Entity type:Organization
Organization Name:SALINE PHYSICIAN SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR,PHYSICIAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TITSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-6093
Mailing Address - Street 1:PO BOX 1635
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1635
Mailing Address - Country:US
Mailing Address - Phone:501-771-4693
Mailing Address - Fax:501-771-4885
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3353
Practice Address - Country:US
Practice Address - Phone:501-776-6381
Practice Address - Fax:501-776-6350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE PHYSICIAN SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty