Healthcare Provider Details

I. General information

NPI: 1588603351
Provider Name (Legal Business Name): PHYSICIAN'S DAY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 CHENAL PKWY STE 440
LITTLE ROCK AR
72223-5970
US

IV. Provider business mailing address

2705 S ORLANDO ST
PINE BLUFF AR
71603-4718
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-4100
  • Fax: 870-536-9020
Mailing address:
  • Phone: 870-536-4100
  • Fax: 870-536-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAR4179
License Number StateAR

VIII. Authorized Official

Name: CAROLYN J BOWMAN
Title or Position: INSURANCE SUPERVISOR
Credential:
Phone: 870-536-4100