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General NPI Number Information
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NPI Number | 1285622845
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Entity Type | Organization
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Legal Business Name | PHYSICIANS' SURGERY CENTER OF FAYETTEVILLE, LLC
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 3733 N BUSINESS DR SUITE #101
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5203
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Country | US
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Telephone | 479-527-0050
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Fax | 479-527-0030
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Provider Business Mailing Address
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Address Line | 3733 N BUSINESS DR SUITE #101
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5203
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Country | US
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Telephone | 479-527-0050
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Fax | 479-527-0030
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RUSS GREENE
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Credential | R.N.
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Telephone | 479-527-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AR4272
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License Number State | AR
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