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
—
—
261QP2300X
Primary Care Clinic/Center
MC-2949
AR
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/21/2013
Last updated
03/16/2013
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