PINE BLUFF SURGICAL CLINIC, INC (NPI# 1821148586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821148586 |
| Entity Type | Organization |
| Organization Name | PINE BLUFF SURGICAL CLINIC, INC |
| Other Organization Name | PROFESSIONAL MEDICAL REVIEW, INC |
| Practice Address |
316 W 6th Ave Pine Bluff AR 71601-4217 |
| Practice Telephone | 8708506053 |
| Practice Fax Number | 8708506482 |
| Mailing Telephone | 8708506053 |
| Mailing Fax Number | 8708506482 |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2009-04-29 |
| Authorized Official Name | DR. GEORGE VAIDEN ROBERSON (PRESIDENT) |
| Authorized Official Telephone | 8708506053 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | R1682 | AR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 103023002 | 05 |
| Other Name | Type Code |
|---|---|
| PROFESSIONAL MEDICAL REVIEW, INC | Doing Business As Name - Organization |
| Street Address |
316 W 6TH AVE |
| City | PINE BLUFF |
| State | AR |
| Zip Code | 71601-4217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710981261 | John David Hardin | Radiology | 316 W 6th Ave, Ste A, Pine Bluff, AR 71601-4217 | 2005-06-10 |
| 1952420846 | Living Hope Medical Services | Psychiatry & Neurology | 316 W 6th Ave, Pine Bluff, AR 71601-4217 | 2007-03-29 |
| 1548206543 | Delta Diagnostic & Therapeutic Rad | Radiology | 316 W 6th Ave, Pine Bluff, AR 71601-4217 | 2006-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162863 | Kb's Adult Health Day Care Center | Clinic/Center | 2911 South Market Street, Pine Bluff, AR 71601 | 2020-10-19 |
| 1184244600 | Chelsea Briggs | Prosthetic/Orthotic Supplier | 601 S Main St Apt 514, Pine Bluff, AR 71601 | 2020-04-24 |
| 1407489081 | Katherine Bolden | Clinic/Center | 2911 East Market Street, Pine Bluff, AR 71601 | 2020-02-21 |
| 1851836829 | Rocky Mountain Holdings, LLC | Ambulance | 613b Hangar Row, Pine Bluff, AR 71601 | 2016-12-30 |
| 1316324494 | Nora Elizabeth Horton | Specialist/Technologist | 2003 University Drive, Suite 2, Pine Bluff, Ar, AR 71601 | 2015-04-28 |
| 1780003665 | Sameer R. Shelat | Internal Medicine | 4125, Rhinehart Road, Pine Bluff, AR 71601 | 2014-04-08 |
| 1700150471 | Community Empowerment Council, Inc. | Social Worker | 5830 Hwy 65 South, Pine Bluff, AR 71601 | 2012-02-28 |
| 1922243807 | The Pine Bluff Group, Pllc | Chiropractor | 2102 S. Olive St., Pine Bluff, AR 71601 | 2008-12-08 |
| 1053571711 | Jefferson Comprehensive Care System Inc | Clinic/Center | 1101 Tennssee, Pine Bluff, AR 71601 | 2008-06-16 |
| 1144404799 | The P.a.t. (people Advocating Transition) Center | Counselor | 620 South Laurel, Pine Bluff, AR 71601 | 2007-12-18 |
| Find all providers in zip 71601 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164709036 | Abdul Ezeldin M.d. P.a. | Specialist | 1801 W 40th Ave Ste 5c, Pine Bluff, AR 71603-6962 | 2011-11-07 |
| 1447492996 | Travis J. Goodnight, M. D., Pa | Specialist | 1609 West 40th, Ste 403, Pine Bluff, AR 71603 | 2009-03-30 |
| 1649440637 | Calvin M Bracy | Specialist | 1301 W 43rd Ave, Pine Bluff, AR 71603-7024 | 2008-03-05 |
| 1780891309 | Urology Associates of South Arkansas | Specialist | 1609 W 40th Ave Ste 301, Pine Bluff, AR 71603-6366 | 2007-05-16 |
| 1598771677 | Steven Howard Wright | Specialist | 1614 W 42nd Ave, Pine Bluff, AR 71603-7006 | 2006-07-31 |
| 1295761419 | South Arkansas Heart & Vascular Associates, P.a. | Specialist | 4201 S Mulberry St, Pine Bluff, AR 71603-7016 | 2006-06-23 |
| 1760448542 | Arkansas Cancer Clinic, Pa | Specialist | 7200 South Hazel, Pine Bluff, AR 71603 | 2006-04-21 |
| 1841262300 | Ruston Pierce | Specialist | 1702 W 42nd Ave, Pine Bluff, AR 71603-7008 | 2006-02-07 |
| 1548230881 | Pulmonary Medicine Clinic Pa | Specialist | 1710 W 42nd Ave, Pine Bluff, AR 71603-7008 | 2006-01-26 |
| 1457345704 | L Milton Hughes | Specialist | 1414 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2005-09-01 |
| Find all providers in PINE BLUFF | ||||
| City | PINE BLUFF |
| Zip Code | 71601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.