Pine Bluff Surgical Clinic, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

R1682 Issued in AR

Legal business name

PINE BLUFF SURGICAL CLINIC, INC

Practice address

316 W 6TH Ave
Pine Bluff, AR 71601-4217

Phone

(870) 850-6053

Fax

(870) 850-6482

NPI assigned

Jan 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. George Vaiden Roberson, M.D.

Title

President

Phone

(870) 850-6053

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PROFESSIONAL MEDICAL REVIEW, INC Doing business as

Locations

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240963200000",
    "number": "1821148586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 W 6TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716014217",
            "telephone_number": "870-850-6053",
            "fax_number": "870-850-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 W 6TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716014217",
            "telephone_number": "870-850-6053",
            "fax_number": "870-850-6482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE BLUFF SURGICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2009-04-29",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "VAIDEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-850-6053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "R1682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103023002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROFESSIONAL MEDICAL REVIEW, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pine Bluff Endoscopy Center, LLC
• Pine Bluff Nursing, LLC
• Pine Bluff Pathologists PLLC
• Pine Bluff Radiologists, LTD
• Pine Bluff School District
• Pine Ridge Healthcare, LLC
• James Alan Pollard, MD
• Barbara J Porter
• Positive Place Counseling and Consulting, LLC
• Ashwini Potharam

• Specialist in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; 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.