Provider Demographics
NPI:1427351865
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:
Authorized Official - First Name:KIMBERLY
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 2577
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-2577
Mailing Address - Country:US
Mailing Address - Phone:501-778-0427
Mailing Address - Fax:501-778-5993
Practice Address - Street 1:910 N EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3327
Practice Address - Country:US
Practice Address - Phone:501-778-0427
Practice Address - Fax:501-778-5993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE COUNTY MEDICAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare PIN