Healthcare Provider Details

I. General information

NPI: 1053301473
Provider Name (Legal Business Name): BAKER AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 MERRIMAN ST
CONWAY AR
72032-4436
US

IV. Provider business mailing address

810 MERRIMAN ST
CONWAY AR
72032-4436
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3937
  • Fax: 501-730-0466
Mailing address:
  • Phone: 501-329-3937
  • Fax: 501-932-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAR3919
License Number StateAR

VIII. Authorized Official

Name: DAVID LITTLETON BAKER JR.
Title or Position: OWNER/ OPHTHALMOLOGIST
Credential: MD
Phone: 501-329-3937