Healthcare Provider Details

I. General information

NPI: 1427662345
Provider Name (Legal Business Name): BENTONVILLE AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 MID CITIES DR
BENTONVILLE AR
72712-4020
US

IV. Provider business mailing address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
US

V. Phone/Fax

Practice location:
  • Phone: 844-215-0731
  • Fax: 888-630-8885
Mailing address:
  • Phone: 507-773-6993
  • Fax: 888-630-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. EILIZABETH ANN WADDELL
Title or Position: ASC ADMINISTRATOR
Credential: RN
Phone: 501-766-1065