Fayetteville Surgical Assoc PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

FAYETTEVILLE SURGICAL ASSOC PA

Practice address

3264 N. North Hills Blvd.
Fayetteville, AR 72703-4005

Phone

(479) 521-3300

Fax

(479) 521-4914

NPI assigned

Nov 29, 2006

Last updated

Jul 22, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Gwen S Mathis

Title

Clinic Administrator

Phone

(479) 521-3300

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1013084631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N. NORTH HILLS BLVD.",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034005",
            "telephone_number": "479-521-3300",
            "fax_number": "479-521-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N. NORTH HILLS BLVD.",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034005",
            "telephone_number": "479-521-3300",
            "fax_number": "479-521-4914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE SURGICAL ASSOC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "479-521-3300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111799002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.