Basic Information
| Provider Information | |||||||||
| NPI: | 1588603351 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN'S DAY SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2705 S ORLANDO ST | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716034718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705364100 | ||||||||
| FaxNumber: | 8705369020 | ||||||||
| Practice Location | |||||||||
| Address1: | 17200 CHENAL PKWY STE 440 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722235970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705364100 | ||||||||
| FaxNumber: | 8705369020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 06/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOWMAN | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8705364100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | AR4179 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.