Healthcare Provider Details

I. General information

NPI: 1538410147
Provider Name (Legal Business Name): SALINE PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PARK DR SUITE 305
BENTON AR
72015-3729
US

IV. Provider business mailing address

PO BOX 2577
BENTON AR
72018-2577
US

V. Phone/Fax

Practice location:
  • Phone: 501-574-7400
  • Fax: 501-574-7401
Mailing address:
  • Phone: 501-776-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY TITSWORTH
Title or Position: DIRECTOR, PHYSICIAN SERVICES
Credential:
Phone: 501-776-6093