EXECUTIVE PARK SURGERY CENTER, LLC (NPI# 1699736777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699736777 |
| Entity Type | Organization |
| Organization Name | EXECUTIVE PARK SURGERY CENTER, LLC |
| Practice Address |
3314 S 70th St Fort Smith AR 72903-5052 |
| Practice Telephone | 4794242744 |
| Practice Fax Number | 4794242745 |
| Mailing Telephone | 4794242744 |
| Mailing Fax Number | 4794242745 |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2010-12-16 |
| Authorized Official Name | RANDY M ENNEN (PRESIDENT) |
| Authorized Official Telephone | 4794242744 |
| Authorized Official Credential | M.D. |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 155824128 | 05 | |
| OK | 200041770A | 05 |
| Street Address |
3314 S 70TH ST |
| City | FORT SMITH |
| State | AR |
| Zip Code | 72903-5052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598068306 | Executive Park Surgery Center of Fort Smith, Inc | Clinic/Center | 3314 S 70th St, Fort Smith, AR 72903-5052 | 2010-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285280016 | Bhg L, LLC | Clinic/Center | 1501 Waldron Road, Ste 203, Fort Smith, AR 72903 | 2019-08-16 |
| 1457905903 | Heather Snyder | Optometrist | 1021 South Waldron Road, Fort Smith, AR 72903 | 2019-08-01 |
| 1083272223 | Pediatric Therapy Connections LLC | Clinic/Center | 7601 Westminister Pl, Fort Smith, AR 72903 | 2019-06-03 |
| 1073092821 | Baptist Health Services | Psychiatry & Neurology | 3808 Gary St Ste B, Fort Smith, AR 72903 | 2018-08-13 |
| 1104305853 | Baptist Health Services | Family Medicine | 5428 Ellsworth Rd Ste A, Fort Smith, AR 72903 | 2018-08-13 |
| 1417436171 | Baptist Health Services | Pediatrics | 5428 Ellsworth Rd Ste B, Fort Smith, AR 72903 | 2018-08-13 |
| 1558840421 | Baptist Health Services | Family Medicine | 3808 Gary St Ste A, Fort Smith, AR 72903 | 2018-08-10 |
| 1316434707 | Md Weight Loss and Wellness, LLC | Dietitian, Registered | 3416 Old Greenwood Road, Fort Smith, AR 72903 | 2018-04-20 |
| 1942695572 | Donna K Morgan | Counselor | 2408 S. 51st Court Suite G, Fort Smith, AR 72903 | 2015-03-31 |
| 1346658242 | Shelby Mural Esry | Dentist | 3200 Rogers Ave. Suite 111, Fort Smith, AR 72903 | 2014-07-24 |
| Find all providers in zip 72903 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598074551 | Western Arkansas Surgical Center | Clinic/Center | 3501 W. E. Knight Dr, Fort Smith, AR 72917 | 2010-09-24 |
| 1851467831 | Phoenix Health Associates of Fort Smith | Clinic/Center | 3601 W E Knight Drive, Fort Smith, AR 72903 | 2006-11-28 |
| 1902860679 | Vision Group Asc, LLC | Clinic/Center | 3002 Rogers Ave, Fort Smith, AR 72901-4232 | 2006-04-12 |
| 1831182641 | Mercy Ambulatory Surgery Center, LLC | Clinic/Center | 7301 Rogers Ave, Fort Smith, AR 72903-4100 | 2005-08-26 |
| 1598068306 | Executive Park Surgery Center of Fort Smith, Inc | Clinic/Center | 3314 S 70th St, Fort Smith, AR 72903-5052 | 2010-12-16 |
| 1215024575 | Cooper Clinic Pa | Clinic/Center | 6801 Rogers Ave, Fort Smith, AR 72903-4067 | 2006-10-06 |
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|---|---|---|---|---|
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| 1477178879 | Surgcenter of Fayetteville, LLC | Clinic/Center | 1905 E Mission Blvd Ste 5, Fayetteville, AR 72703-3129 | 2020-06-11 |
| 1346878303 | Hot Springs Ambulatory Surgery Center, LLC | Clinic/Center | 148 Sawtooth Oak St, Hot Springs, AR 71901 | 2020-03-27 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1487122669 | Conway Cardiovascular Surgery Center, LLC | Clinic/Center | 650 United Dr Ste 120, Conway, AR 72032-7826 | 2018-11-06 |
| 1194209437 | Precision Surgical Center of Northwest Arkansas, LLC | Clinic/Center | 3728 S Pinnacle Hills Pkwy, Rogers, AR 72758-8897 | 2018-09-22 |
| 1609399963 | Interventional Surgery Institute of White Hall LLC | Clinic/Center | 7211 Dollarway Road, White Hall, AR 71602 | 2017-07-19 |
| 1679001028 | Centerview Surgery Center, LLC | Clinic/Center | 1310 Centerview Dr, Little Rock, AR 72211-4349 | 2017-05-30 |
| 1386177376 | Executive Surgery Center of Little Rock, LLC | Clinic/Center | 11220 Executive Center Dr, Suite 100, Little Rock, AR 72211-4320 | 2017-04-06 |
| 1639615297 | Surgery Center At The Reserve, P.a., Inc. | Clinic/Center | 2241 Hillpark Cove, Suite B, Jonesboro, AR 72401 | 2017-01-06 |
| Find all providers with the same taxonomy | ||||
| City | FORT SMITH |
| Zip Code | 72903 |
Please comment or provide details below to improve the information on EXECUTIVE PARK SURGERY CENTER, 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.