Basic Information
| Provider Information | |||||||||
| NPI: | 1538538905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS DAY SURGERY CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PDSC ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1649 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720331649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705364100 | ||||||||
| FaxNumber: | 8705343982 | ||||||||
| Practice Location | |||||||||
| Address1: | 17200 CHENAL PKWY | ||||||||
| Address2: | STE 440 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722235958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018302020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2015 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROPER | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5017714693 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.B.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.