Healthcare Provider Details

I. General information

NPI: 1831182641
Provider Name (Legal Business Name): MERCY AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

PO BOX 17009
FORT SMITH AR
72917-7009
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6275
  • Fax: 479-314-6276
Mailing address:
  • Phone: 479-314-6275
  • Fax: 479-314-6276

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: MONTE A WILSON
Title or Position: PRESIDENT
Credential:
Phone: 479-314-5722