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General NPI Number Information
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NPI Number | 1841530318
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL MEDICAL SERVICES PA
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 03/16/2013
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Provider Practice Location Address
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Address Line | 5212 VILLAGE PKWY SUITE 2
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City | ROGERS
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State | AR
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Zip | 72758-8104
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Country | US
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Telephone | 479-657-6888
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Fax | 479-434-5572
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Provider Business Mailing Address
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Address Line | 701 S 21ST ST
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City | FORT SMITH
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State | AR
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Zip | 72901-4001
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Country | US
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Telephone | 501-551-3556
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Fax | 800-861-7171
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHESTER L. CARLSON
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Credential | D.O.
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Telephone | 501-551-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MC-2949
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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