MEDICARE: SHERIDAN HEALTHCARE OF ARKANSAS PA

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	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699758169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN HEALTHCARE OF ARKANSAS PA

Provider Business Mailing Address
First Line	:	PO BOX 452035
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33345-2035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W GROVE ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4416
Country	:	US
Telephone Number	:	870-864-3390
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHLEEN KONDAS
Credential	:
Telephone Number	:	954-838-2371

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/18/2019

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