MEDICARE: OUTPATIENT SURGERY CENTER OF JONESBORO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	AR4142	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598758153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTPATIENT SURGERY CENTER OF JONESBORO LLC

Provider Business Mailing Address
First Line	:	1100 E MATTHEWS AVE
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4314
Country	:	US
Telephone Number	:	870-935-8500
Fax Number	:	870-932-6435

Provider Business Practice Location Address
First Line	:	1100 E MATTHEWS AVE
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4314
Country	:	US
Telephone Number	:	870-935-8500
Fax Number	:	870-932-6435

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	MRS. KERRI LYNN PARNELL
Credential	:
Telephone Number	:	870-935-8500

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	05/05/2010

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