Basic Information
| Provider Information | |||||||||
| NPI: | 1891099537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALINE PHYSICIAN SERVICES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SALINE OB/GYN ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707440834 | ||||||||
| Practice Location | |||||||||
| Address1: | 23157 I 30 | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRYANT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720222592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018470834 | ||||||||
| FaxNumber: | 5018471731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2011 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | ALFORD | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | DON | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5017766015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SALINE PHYSICIAN SERVICES, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.