Healthcare Provider Details

I. General information

NPI: 1093825002
Provider Name (Legal Business Name): SALINE ORTHOPEDIC GROUP P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ACTIVE WAY
BENTON AR
72022-9267
US

IV. Provider business mailing address

PO BOX 3250
BENTON AR
72018-3250
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-0984
  • Fax: 501-847-1405
Mailing address:
  • Phone: 501-315-0984
  • Fax: 501-847-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRY J LORIO
Title or Position: PHYSICIAN
Credential:
Phone: 501-315-0984