MEDICARE: CSS HEALTHCARE, LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1780105015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSS HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1384
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71731-1384
Country	:	US
Telephone Number	:	870-639-3910
Fax Number	:	870-639-3913

Provider Business Practice Location Address
First Line	:	525 W FAULKNER ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4518
Country	:	US
Telephone Number	:	870-639-3910
Fax Number	:	870-639-3913

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MELISSA LANGSTON
Credential	:
Telephone Number	:	870-639-3910

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	06/27/2017

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Directions to “CSS HEALTHCARE, LLC ” Practice Location

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