NPIMap

Organization Active NPI

Mississippi County Surgical Assn

  • Surgery Physician
  • Blytheville, AR
National Provider Identifier
1700921293
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
C4476 Issued in AR
Legal business name
MISSISSIPPI COUNTY SURGICAL ASSN
Practice address
1100 Medical Dr Ste D
Blytheville, AR 72315-2437
Phone
(870) 762-1208
Fax
(870) 762-6588
NPI assigned
Feb 21, 2007
Last updated
Apr 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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

Authorized official

Name
Dr. Raymond Scott Fergus, MD
Title
President
Phone
(870) 762-1208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X C4476 AR Primary

Addresses

Primary practice location

1100 Medical Dr Ste D
Blytheville, AR 72315-2437

Mailing address

PO Box 186
Blytheville, AR 72316-0186
Phone (870) 762-1208

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208131200000",
    "number": "1700921293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 186",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723160186",
            "telephone_number": "870-762-1208",
            "fax_number": "870-762-6588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MEDICAL DR STE D",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723152437",
            "telephone_number": "870-762-1208",
            "fax_number": "870-762-6588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COUNTY SURGICAL ASSN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2008-04-14",
        "status": "A",
        "authorized_official_last_name": "FERGUS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-762-1208",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "C4476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blytheville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.