NPIMap

Organization Active NPI

South Central Medical Services, P.a.

Doing business as Renaissance Health and Wellness

  • General Practice Physician
  • Little Rock, AR
National Provider Identifier
1497168397
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
E5307 Issued in AR
Legal business name
SOUTH CENTRAL MEDICAL SERVICES, P.A.
Doing business as
Renaissance Health and Wellness
Practice address
600 Autumn Rd
Little Rock, AR 72211-3606
Phone
(501) 448-2342
Fax
(501) 221-0615
NPI assigned
Jun 9, 2014
Last updated
Jun 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chester L Carlson, D.O.NPI 1164544045
Title
Owner/Medical Director
Phone
(479) 657-6888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X E5307 AR Primary

Addresses

Primary practice location

600 Autumn Rd
Little Rock, AR 72211-3606

Mailing address

PO Box 11020
Fort Smith, AR 72917-1020
Phone (479) 434-4887

Other names 1

  • Renaissance Health and Wellness Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402272000000",
    "number": "1497168397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11020",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729171020",
            "telephone_number": "479-434-4887",
            "fax_number": "479-434-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 AUTUMN RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113606",
            "telephone_number": "501-448-2342",
            "fax_number": "501-221-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL MEDICAL SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-09",
        "last_updated": "2014-06-09",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "CHESTER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "479-657-6888",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "E5307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.