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General NPI Number Information
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NPI Number | 1639615297
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER AT THE RESERVE, P.A., INC.
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 2241 HILLPARK COVE SUITE B
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-333-5747
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Fax |
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Provider Business Mailing Address
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Address Line | 2241 HILLPARK COVE SUITE B
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-333-5747
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | MR. KEITH CHRESTMAN
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Credential |
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Telephone | 870-933-8517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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