Healthcare Provider Details

I. General information

NPI: 1932520764
Provider Name (Legal Business Name): SOUTH ARKANSAS EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JOHNSON MILL BLVD
JOHNSON AR
72741-0001
US

IV. Provider business mailing address

PO BOX 602162
CHARLOTTE NC
28260-2162
US

V. Phone/Fax

Practice location:
  • Phone: 479-684-3000
  • Fax:
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DERIK K KING
Title or Position: LLP MANAGING PARTNER
Credential:
Phone: 866-916-5259