# SOUTH ARKANSAS PHYSICIAN SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427018704
- **Authorized official:** JENNIFER L JACKSON (SR. DIRECTOR PROVIDER ENROLLMENT)
- **Authorized official phone:** (877) 892-9815

## Contact information

- **Practice address:** 700 W GROVE ST, EL DORADO, AR 71730-4416
- **Practice address phone:** (870) 863-2000
- **Mailing address:** 7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
- **Mailing address phone:** (615) 465-7000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 03/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 145507002 | — | AR |