Healthcare Provider Details

I. General information

NPI: 1841530318
Provider Name (Legal Business Name): SOUTH CENTRAL MEDICAL SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 03/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 VILLAGE PKWY SUITE 2
ROGERS AR
72758-8104
US

IV. Provider business mailing address

701 S 21ST ST
FORT SMITH AR
72901-4001
US

V. Phone/Fax

Practice location:
  • Phone: 479-657-6888
  • Fax: 479-434-5572
Mailing address:
  • Phone: 501-551-3556
  • Fax: 800-861-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMC-2949
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHESTER L. CARLSON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 501-551-3556