Provider Demographics
NPI:1538226923
Name:SURGICAL ASSOCIATES OF ARKANSAS
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-280-0499
Mailing Address - Street 1:PO BOX 7570
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72217-7570
Mailing Address - Country:US
Mailing Address - Phone:501-661-8207
Mailing Address - Fax:501-661-0304
Practice Address - Street 1:9712 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2124
Practice Address - Country:US
Practice Address - Phone:501-280-0499
Practice Address - Fax:501-217-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR208G00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150105002Medicaid
AR150105002Medicaid