Healthcare Provider Details

I. General information

NPI: 1568599892
Provider Name (Legal Business Name): SOUTH ARKANSAS ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 VINE ST
EL DORADO AR
71730
US

IV. Provider business mailing address

PO BOX 55990
LITTLE ROCK AR
72215-5990
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-0700
  • Fax: 501-227-0744
Mailing address:
  • Phone: 501-227-0700
  • Fax: 501-227-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR48530
License Number StateAR

VIII. Authorized Official

Name: MS. PAULA A KEYS
Title or Position: MANAGER
Credential: CPC, CCP
Phone: 501-227-0700