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NPI Code Detail

MEDICARE: MERCY AMBULATORY SURGERY CENTER, LLC

MEDICARE: MERCY 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1831182641
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCY AMBULATORY SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 17009
Second Line :
City : FORT SMITH
State : AR
Zip : 72917-7009
Country : US
Telephone Number : 479-314-6275
Fax Number : 479-314-6276
Provider Business Practice Location Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-314-6275
Fax Number : 479-314-6276
Authorized Official
Title or Position : PRESIDENT
Name : MONTE A WILSON
Credential :
Telephone Number : 479-314-5722
Provider Enumeration Date : 08/26/2005
Last Update Date : 08/22/2020

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Directions to “MERCY AMBULATORY SURGERY CENTER, LLC ” Practice Location

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