Provider Demographics
NPI:1265404669
Name:NORTH RIVER SURGERY CENTER, LLC
Entity type:Organization
Organization Name:NORTH RIVER SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:501-834-5777
Mailing Address - Street 1:2209 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5074
Mailing Address - Country:US
Mailing Address - Phone:501-834-5777
Mailing Address - Fax:501-834-0126
Practice Address - Street 1:2209 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5074
Practice Address - Country:US
Practice Address - Phone:501-834-5777
Practice Address - Fax:501-834-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3567261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11035OtherBLUE CROSS BLUE SHIELD
AR133949728Medicaid
AR133949728Medicaid