Healthcare Provider Details

I. General information

NPI: 1760429666
Provider Name (Legal Business Name): OUACHITA SURGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRESTWOOD CIR SUITE P
MENA AR
71953-5512
US

IV. Provider business mailing address

400 CRESTWOOD CIR SUITE P
MENA AR
71953-5512
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-1414
  • Fax: 479-394-2612
Mailing address:
  • Phone: 479-394-1414
  • Fax: 479-394-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR3688
License Number StateAR

VIII. Authorized Official

Name: DR. THOMAS JOHN TINNESZ
Title or Position: GENERAL SURGEON
Credential: M.D.
Phone: 479-394-1414