Executive Park Surgery Center, Llc

LBN: Executive Park Surgery Center, Llc
Executive Park Surgery Center, Llc is an health care organization with primary practice located at 3314 S 70Th St , Fort Smith AR 72903-5052. The organization recently has only one registered license in Ambulatory Health Care Facilities / Ambulatory Surgical, which is considered as the primary health care specialty. Executive Park Surgery Center, Llc can be contacted via phone (479) 424-2744, or through Ennen, Randy M via phone (479) 424-2744.

Contact Information

Primary practice address
3314 S 70Th St Fort Smith AR 72903-5052
Phone: (479) 424-2744
Fax: (479) 424-2745
Website:
Map and Directions
Authorized official contact:
Name: Ennen, Randy M Doctor of Medicine (MD)
Phone: (479) 424-2744

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Ambulatory Surgical 261QA1903X

Profile Details

NPI number 1699736777
LBN Legal business name Executive Park Surgery Center, Llc
DBA Doing business as
Authorized official Ennen, Randy M Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 29th, 2006
Last updated Dec 16th, 2010 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699736777 NPPES
Oklahoma MEDICAID 200041770A
Oklahoma MEDICAID 155824128

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