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General NPI Number Information
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NPI Number | 1457379364
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Entity Type | Organization
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Legal Business Name | JONESBORO SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 623 E MATTHEWS AVE SUITE C
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City | JONESBORO
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State | AR
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Zip | 72401-3145
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Country | US
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Telephone | 870-934-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 623 E MATTHEWS AVE SUITE C
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City | JONESBORO
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State | AR
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Zip | 72401-3145
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGIE CARLTON
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Credential |
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Telephone | 870-932-2211
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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 | AR3943
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License Number State | AR
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