Healthcare Provider Details

I. General information

NPI: 1417439944
Provider Name (Legal Business Name): ARKANSAS SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EXCHANGE AVE STE 102B
CONWAY AR
72032-7833
US

IV. Provider business mailing address

5201 NORTHSHORE DR
NORTH LITTLE ROCK AR
72118-5312
US

V. Phone/Fax

Practice location:
  • Phone: 501-504-6994
  • Fax: 501-504-6985
Mailing address:
  • Phone: 501-748-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER BRIAN FOWLER
Title or Position: CEO
Credential:
Phone: 501-748-8089