MEDICARE: MASSARD AMBULATORY SURGERY CENTER, LLC

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

General Provider Information

NPI Number	:	1104683374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSARD AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	108 N SHACKLEFORD RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2840
Country	:	US
Telephone Number	:	501-766-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	8306 MASSARD CREEK CT
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6084
Country	:	US
Telephone Number	:	844-215-0731
Fax Number	:	888-630-8885

Authorized Official
Title or Position	:	VP OF SURGICAL SERVICES
Name	:	ELIZABETH WADDELL
Credential	:	RN
Telephone Number	:	501-766-1065

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	06/23/2026

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