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Organization
SOUTH CENTRAL MEDICAL SERVICES PA
Active
Organization
SOUTH CENTRAL MEDICAL SERVICES PA
Active
Other names
Renaissance Health and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHESTER L. CARLSON D.O. (PRESIDENT)
(501) 551-3556
Entity
Organization
Contact information
Practice address
5212 VILLAGE PKWY, SUITE 2, ROGERS, AR 72758-8104
(479) 657-6888
(479) 434-5572
Mailing address
701 S 21ST ST, FORT SMITH, AR 72901-4001
(501) 551-3556
(800) 861-7171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
MC-2949
AR
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/21/2013
Last updated
03/16/2013
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