Healthcare Provider Details

I. General information

NPI: 1780913822
Provider Name (Legal Business Name): SALINE PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK DR
BENTON AR
72015-3353
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 501-776-6381
  • Fax: 501-776-6350
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. LARRY DON ALFORD
Title or Position: CFO
Credential:
Phone: 501-776-6015