NPIMap

Organization Active NPI

Physicians Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Blytheville, AR
National Provider Identifier
1114906393
Registry record updated Jan 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
AR4222 Issued in AR
Legal business name
PHYSICIANS SURGERY CENTER LLC
Practice address
3327 S Division St
Blytheville, AR 72315-5123
Phone
(870) 762-1942
Fax
(870) 763-0787
NPI assigned
Jan 16, 2006
Last updated
Jan 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2009

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

Authorized official

Name
Mrs. Constance H Smith, M.D.NPI 1760462584
Title
Ceo
Phone
(870) 762-1942

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X AR4222 AR Primary

Addresses

Primary practice location

3327 S Division St
Blytheville, AR 72315-5123

Mailing address

PO Box 92
Blytheville, AR 72316-0092
Phone (870) 762-1942

Other identifiers 1

IdentifierTypeStateIssuer
154372128MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040826001043 AR Part B Supplier - Ambulatory Surgical Center 3476528159 Practice locations: Blytheville, AR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Physicians Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3327 S Division St
Blytheville, AR 72315
Phone (870) 762-1590

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231113600000",
    "number": "1114906393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723160092",
            "telephone_number": "870-762-1942",
            "fax_number": "870-763-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3327 S DIVISION ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723155123",
            "telephone_number": "870-762-1942",
            "fax_number": "870-763-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-16",
        "last_updated": "2009-01-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-762-1942",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AR",
            "license": "AR4222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154372128",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blytheville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.