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General NPI Number Information
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NPI Number | 1023165263
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Entity Type | Organization
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Legal Business Name | MENA GENERAL SURGICAL SERVICES, L.L.C.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 400 CRESTWOOD CIR STE K
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City | MENA
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State | AR
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Zip | 71953-5512
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Country | US
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Telephone | 479-394-6600
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Fax | 479-394-3610
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Provider Business Mailing Address
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Address Line | PO BOX 295
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City | LOCKESBURG
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State | AR
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Zip | 71846-0295
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Country | US
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Telephone | 870-289-5865
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Fax | 870-289-6993
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Authorized Official
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Title or Position | OWNER
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Name | ROGER CASADY
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Credential | M.D.
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Telephone | 870-289-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E3204
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License Number State | AR
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