FAYETTEVILLE SURGICAL ASSOC PA (NPI# 1013084631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013084631 |
| Entity Type | Organization |
| Organization Name | FAYETTEVILLE SURGICAL ASSOC PA |
| Practice Address |
3264 N. North Hills Blvd. Fayetteville AR 72703-4005 |
| Practice Telephone | 4795213300 |
| Practice Fax Number | 4795214914 |
| Mailing Telephone | 4795213300 |
| Mailing Fax Number | 4795214914 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2013-07-22 |
| Authorized Official Name | MRS. GWEN S MATHIS (CLINIC ADMINISTRATOR) |
| Authorized Official Telephone | 4795213300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 111799002 | 05 |
| Street Address |
3264 N. NORTH HILLS BLVD. |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-4005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851375158 | Jeffrey D. Bell | Surgery | 3264 N. North Hills Blvd., 377th Medical Group, Fayetteville, AR 72703-4005 | 2005-12-01 |
| 1124085469 | Jon M Berry | Surgery | 3264 N. North Hills Blvd., Fayetteville Surgical Associates Pa, Fayetteville, AR 72703-4005 | 2006-04-28 |
| 1205892213 | M Gareth Eck | Surgery | 3264 N. North Hills Blvd., Fayetteville, AR 72703-4005 | 2006-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1962062240 | Shenika Twanet Judd | Specialist | 724 N Reilly Rd Ste C, Fayetteville, NC 28303-6042 | 2019-06-18 |
| 1033676358 | Suzanne Lynn Washburn | Specialist | 307 Barcelona Drive 26e, Fayetteville, NC 28303-5768 | 2019-02-22 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1194203075 | Dominique A Hunter | Specialist | 100 Hay St Fl 6, Fayetteville, NC 28301-5676 | 2018-08-01 |
| 1699286260 | Carla Jai Simmons | Specialist | 1300 Bragg Blvd Ste 1318, Fayetteville, NC 28301-4296 | 2017-10-23 |
| 1952825838 | Mary L Hill | Specialist | 185 Thornton Dr., Fayetteville, GA 30214 | 2017-08-01 |
| 1295288215 | Jillian Diffenbaugh | Specialist | 1019 Hay St, Fayetteville, NC 28305-5315 | 2016-07-26 |
| 1437534633 | Mark Hinton | Specialist | 131 Barnhill Arena Office, Office 116a, Fayetteville, AR 72701 | 2015-07-29 |
| 1841600830 | Trimana LLC | Specialist | 2875 E Joyce Blvd, Fayetteville, AR 72703-4524 | 2014-04-30 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
Please comment or provide details below to improve the information on FAYETTEVILLE SURGICAL ASSOC PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.