MEDICARE: SURGICAL ASSOCIATES OF CROSSETT, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E1594	AR

General Provider Information

NPI Number	:	1467410027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ASSOCIATES OF CROSSETT, PA

Provider Business Mailing Address
First Line	:	PO BOX 1095
Second Line	:
City	:	CROSSETT
State	:	AR
Zip	:	71635-1095
Country	:	US
Telephone Number	:	870-364-4013
Fax Number	:	870-364-4184

Provider Business Practice Location Address
First Line	:	1015 UNITY RD
Second Line	:
City	:	CROSSETT
State	:	AR
Zip	:	71635-9443
Country	:	US
Telephone Number	:	870-364-4013
Fax Number	:	870-364-4184

Authorized Official
Title or Position	:	OWNER/SURGEON
Name	:	DR. ALAN KIRK WILSON
Credential	:	MD
Telephone Number	:	870-364-4013

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/22/2020

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