Provider Demographics
NPI:1376224352
Name:FORT SMITH AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FORT SMITH AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF SURGICAL SERV
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-766-1065
Mailing Address - Street 1:108 N SHACKLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2840
Mailing Address - Country:US
Mailing Address - Phone:844-215-0731
Mailing Address - Fax:
Practice Address - Street 1:8306 MASSARD CREEK CT
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6084
Practice Address - Country:US
Practice Address - Phone:844-215-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty