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General NPI Number Information
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NPI Number | 1396634820
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Entity Type | Organization
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Legal Business Name | LAKESIDE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 6845 ISAACS ORCHARD RD
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City | SPRINGDALE
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State | AR
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Zip | 72762
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Country | US
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Telephone | 473-236-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 741 E VAN ASCHE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4916
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Country | US
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Telephone | 473-442-5227
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Fax | 472-582-4952
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PETER MARSHALL DAUT
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Credential | MD
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Telephone | 479-442-5227
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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 |
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License Number State |
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