EXECUTIVE PARK SURGERY CENTER LLC NPI 1699736777

NPI Information

EXECUTIVE PARK SURGERY CENTER, LLC is an ambulatory surgical clinic center in Fort Smith, AR. EXECUTIVE PARK SURGERY CENTER, LLC NPI is 1699736777. The provider is registered as an organization entity type.

The provider's business location address is:

3314 S 70TH ST
FORT SMITH, AR
ZIP 72903-052
Phone: (479) 424-2744
Fax: (479) 424-2745

The provider's authorized official is Randy M Ennen .
The authorized official title is President and has the following contact phone number (479) 424-2744.

The CLIA number assigned to this NPI record is 04D1022158 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/29/2006 and was last updated on 12/16/2010.

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

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