Provider Demographics
NPI:1730131731
Name:SPRINGDALE BENTONVILLE SURGERY CENTER LP
Entity Type:Organization
Organization Name:SPRINGDALE BENTONVILLE SURGERY CENTER LP
Other - Org Name:NORTHWEST AMBULATORY SURGERY CENTER - SPRINGDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 842494
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2494
Mailing Address - Country:US
Mailing Address - Phone:479-750-5800
Mailing Address - Fax:479-685-7262
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-5800
Practice Address - Fax:479-685-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4278261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158419128Medicaid
11063Medicare PIN