SURGCENTER OF FAYETTEVILLE, LLC (NPI# 1477178879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477178879 |
| Entity Type | Organization |
| Organization Name | SURGCENTER OF FAYETTEVILLE, LLC |
| Practice Address |
1905 E Mission Blvd Ste 5 Fayetteville AR 72703-3129 |
| Practice Telephone | 5015541273 |
| Mailing Telephone | 5015541273 |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |
| Authorized Official Name | KELLI YOUNG (ADMINSITRATOR) |
| Authorized Official Telephone | 5015541273 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
1905 E MISSION BLVD STE 5 |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-3129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831798586 | Fayetteville Anesthesia Associates LLC | Nurse Anesthetist, Certified Registered | 1905 E Mission Blvd Ste 5, Fayetteville, AR 72703-3129 | 2020-10-23 |
| 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 | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750905618 | Rsps Fayetteville Asc Lllp | Clinic/Center | 874 Lanier Ave W Ste 270, Fayetteville, GA 30214-7617 | 2020-06-05 |
| 1396298139 | Resurgens Fayette Surgery Center, LLC | Clinic/Center | 1336 Highway 54 W Bldg 400, Fayetteville, GA 30214-4535 | 2016-07-28 |
| 1447630876 | Ortho Atlanta Surgery Center of Fayetteville | Clinic/Center | 1265 Highway 54 W Ste 103, Fayetteville, GA 30214-4537 | 2015-06-01 |
| 1801196050 | Agcny East LLC | Clinic/Center | Northeast Medical Building Condominium, Suite 308, Fayetteville, NY 13066-6638 | 2010-10-21 |
| 1265679674 | Georgia Urology Fayette Asc | Clinic/Center | 140 Carnegie Pl, Suite 108, Fayetteville, GA 30214-7913 | 2009-01-07 |
| 1093907339 | Taylor Surgery Center, LLC | Clinic/Center | 3733 N Business Dr Ste 101, Fayetteville, AR 72703-5286 | 2007-08-10 |
| 1386737021 | Arkansas Outpatient Eye Surgery LLC | Clinic/Center | 3689 N Steele Blvd, Fayetteville, AR 72703-5347 | 2006-10-02 |
| 1033154364 | Paula Pons Physician LLC | Clinic/Center | 4206 Medical Center Dr Ste 203, Fayetteville, NY 13066 | 2006-06-19 |
| 1285622845 | Physicians' Surgery Center of Fayetteville, LLC | Clinic/Center | 3733 N Business Dr, Suite #101, Fayetteville, AR 72703-5203 | 2005-10-07 |
| 1447791074 | Pca Interventional Spine At Fayette, LLC | Clinic/Center | 1233 Highway 54 W, Suite 205, Fayetteville, GA 30214-4542 | 2017-03-15 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
Please comment or provide details below to improve the information on SURGCENTER OF FAYETTEVILLE, LLC.
| 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.