1750333795 NPI number — SPRINGDALE BENTONVILLE SURGERY CENTER LP

Table of content: (NPI 1750333795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750333795 NPI number — SPRINGDALE BENTONVILLE SURGERY CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGDALE BENTONVILLE SURGERY CENTER LP
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:
6
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:
1750333795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-418-5300
Provider Business Mailing Address Fax Number:
479-418-5330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 MEDICAL CENTER PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-418-5300
Provider Business Practice Location Address Fax Number:
479-418-5330
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR BUSINESS OFFICE SUPPORT
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  AR-4298 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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