1326228370 NPI number — ADVANCED AMBULATORY SURGERY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326228370 NPI number — ADVANCED AMBULATORY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED AMBULATORY SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326228370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1444 E STEARNS ST
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-6243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-966-4972
Provider Business Mailing Address Fax Number:
479-966-4655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1444 E STEARNS ST
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-6243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-966-4972
Provider Business Practice Location Address Fax Number:
479-966-4655
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
479-568-8494

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 478741 . This is a "JACHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: AR4579 . This is a "STATE OF ARKANSAS DEPARTMENT OF HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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