Provider Demographics
NPI:1134177256
Name:SPRING CREEK SURGERY CENTER LLC
Entity type:Organization
Organization Name:SPRING CREEK SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:STIBICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-623-7609
Mailing Address - Street 1:3633 CENTRAL AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6404
Mailing Address - Country:US
Mailing Address - Phone:501-623-7609
Mailing Address - Fax:501-623-7156
Practice Address - Street 1:3633 CENTRAL AVENUE
Practice Address - Street 2:SUITE H
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-7609
Practice Address - Fax:501-623-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150031128Medicaid
AR11054Medicare PIN