Healthcare Provider Details

I. General information

NPI: 1316638026
Provider Name (Legal Business Name): SOUTH ARKANSAS PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W GROVE ST
EL DORADO AR
71730-4416
US

IV. Provider business mailing address

2299 CHAMPAGNOLLE RD
EL DORADO AR
71730-4841
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-2000
  • Fax:
Mailing address:
  • Phone: 870-881-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN W JONES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 870-881-9015