MEDICARE: SOUTH CENTRAL MEDICAL SERVICES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	E5307	AR

General Provider Information

NPI Number	:	1538572227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CENTRAL MEDICAL SERVICES, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 11020
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-1020
Country	:	US
Telephone Number	:	479-434-4887
Fax Number	:	479-434-4955

Provider Business Practice Location Address
First Line	:	3401 ROGERS AVE
Second Line	:	SUITE C
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2956
Country	:	US
Telephone Number	:	479-434-4887
Fax Number	:	479-434-4955

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	CHESTER L CARLSON
Credential	:	D.O.
Telephone Number	:	479-657-6888

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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