MEDICARE: PHYSICIANS DAY SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	739	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588603351	OTHER	AR	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023057916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS DAY SURGERY CENTER

Provider Business Mailing Address
First Line	:	2705 S ORLANDO ST
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-4718
Country	:	US
Telephone Number	:	870-536-4100
Fax Number	:	870-536-9020

Provider Business Practice Location Address
First Line	:	2705 S ORLANDO ST
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-4718
Country	:	US
Telephone Number	:	870-536-4100
Fax Number	:	870-536-9020

Authorized Official
Title or Position	:	INSURANCE SUPERVISOR
Name	:	CAROLYN J BOWMAN
Credential	:
Telephone Number	:	870-536-4100

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	10/17/2008

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Directions to “PHYSICIANS DAY SURGERY CENTER ” Practice Location

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