Organization
SOUTH CENTRAL GI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRI BLACKSTOCK MD (OWNER)
(501) 623-7800
Entity
Organization
Contact information
Practice address
124 SAWTOOTH OAK ST, HOT SPRINGS, AR 71901-7160
(501) 623-7800
Mailing address
124 SAWTOOTH OAK ST, HOT SPRINGS, AR 71901-7160
(501) 623-7800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126541001
—
AR
05
—
146525002
—
AR
Enumeration date
03/08/2007
Last updated
04/04/2011
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