EXECUTIVE SURGERY CENTER OF LITTLE ROCK LLC NPI 1386177376

NPI Information

EXECUTIVE SURGERY CENTER OF LITTLE ROCK, LLC is an ambulatory surgical clinic center in Little Rock, AR. EXECUTIVE SURGERY CENTER OF LITTLE ROCK, LLC NPI is 1386177376. The provider is registered as an organization entity type.

The provider's business location address is:

11220 EXECUTIVE CENTER DR
SUITE 100
LITTLE ROCK, AR
ZIP 72211-320
Phone: (501) 312-2121
Fax: (501) 312-2330

The provider's authorized official is Britney Deshae Smith .
The authorized official title is Administrator and has the following contact phone number (501) 312-2121.

The CLIA number assigned to this NPI record is 04D2131280 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2017 and was last updated on 10/13/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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