Healthcare Provider Details

I. General information

NPI: 1467095463
Provider Name (Legal Business Name): OUACHITA PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HOSPITAL DR STE 4
CAMDEN AR
71701-4651
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 870-837-2530
  • Fax: 870-836-1358
Mailing address:
  • Phone: 855-498-6766
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PEGGY L ABBOTT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 870-836-1200