MEDICARE: SOUTH AR SURGICAL CLINIC OF EL DORADO, INC

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

General Provider Information

NPI Number	:	1598978801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH AR SURGICAL CLINIC OF EL DORADO, INC

Provider Business Mailing Address
First Line	:	815 THOMPSON AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4464
Country	:	US
Telephone Number	:	870-862-3411
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 THOMPSON AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4464
Country	:	US
Telephone Number	:	870-862-3411
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	FAY EVANS
Credential	:
Telephone Number	:	870-862-3411

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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