Healthcare Provider Details

I. General information

NPI: 1699758169
Provider Name (Legal Business Name): SHERIDAN HEALTHCARE OF ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W GROVE ST
EL DORADO AR
71730-4416
US

IV. Provider business mailing address

PO BOX 452035
SUNRISE FL
33345-2035
US

V. Phone/Fax

Practice location:
  • Phone: 870-864-3390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 954-838-2371