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General NPI Number Information
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NPI Number | 1467410027
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF CROSSETT, PA
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1015 UNITY RD
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City | CROSSETT
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State | AR
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Zip | 71635-9443
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Country | US
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Telephone | 870-364-4013
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Fax | 870-364-4184
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Provider Business Mailing Address
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Address Line | PO BOX 1095
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City | CROSSETT
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State | AR
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Zip | 71635-1095
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Country | US
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Telephone | 870-364-4013
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Fax | 870-364-4184
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | DR. ALAN KIRK WILSON
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Credential | MD
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Telephone | 870-364-4013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E1594
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License Number State | AR
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