Healthcare Provider Details

I. General information

NPI: 1457077174
Provider Name (Legal Business Name): BATTLE STREET SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 N RODNEY PARHAM RD STE C1-B
LITTLE ROCK AR
72212-4191
US

IV. Provider business mailing address

1701 CENTERVIEW DR STE 114
LITTLE ROCK AR
72211-4311
US

V. Phone/Fax

Practice location:
  • Phone: 501-830-2020
  • Fax: 501-904-3838
Mailing address:
  • Phone: 501-503-4100
  • Fax:

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: HALLIE MUILENBURG
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 501-503-4100