Basic Information
| Provider Information | |||||||||
| NPI: | 1285622845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS' SURGERY CENTER OF FAYETTEVILLE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3733 N BUSINESS DR | ||||||||
| Address2: | SUITE #101 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727035203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795270050 | ||||||||
| FaxNumber: | 4795270030 | ||||||||
| Practice Location | |||||||||
| Address1: | 3733 N BUSINESS DR | ||||||||
| Address2: | SUITE #101 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727035203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795270050 | ||||||||
| FaxNumber: | 4795270030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 04/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | GREENE | ||||||||
| AuthorizedOfficialFirstName: | RUSS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4795270050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | AR4272 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.