Organization
PINE BLUFF SURGICAL CLINIC, INC
Active
Other names
PROFESSIONAL MEDICAL REVIEW, INC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE VAIDEN ROBERSON M.D. (PRESIDENT)
(870) 850-6053
Entity
Organization
Contact information
Practice address
316 W 6TH AVE, PINE BLUFF, AR 71601-4217
(870) 850-6053
(870) 850-6482
Mailing address
316 W 6TH AVE, PINE BLUFF, AR 71601-4217
(870) 850-6053
(870) 850-6482
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R1682
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103023002
—
AR
Enumeration date
01/12/2007
Last updated
04/29/2009
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