Dave Ward Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

DAVE WARD AMBULATORY SURGERY CENTER, LLC

Practice address

2425 Dave Ward Dr
Conway, AR 72034-8686

Phone

(844) 215-0731

Fax

(888) 630-8885

NPI assigned

Feb 16, 2022

Last updated

Feb 16, 2022By 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

Elizabeth Waddell, RN

Title

ASC Administrator

Phone

(501) 766-1065

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811642069. Details of each certification follow.

• CCN 04C0001116 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 04C0001116

Legal name

Dave Ward Ambulatory Surgery Center, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jun 2, 2023

Last certification

May 12, 2023

Ownership / control type

Proprietary

Most recent change of ownership

Jan 24, 2025

Facility address

2425 Dave Ward Drive
Conway, AR 72034

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1811642069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840",
            "telephone_number": "844-215-0731",
            "fax_number": "888-630-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 DAVE WARD DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348686",
            "telephone_number": "844-215-0731",
            "fax_number": "888-630-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVE WARD AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "ASC ADMINISTRATOR",
        "authorized_official_telephone_number": "501-766-1065",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lori Jean Dather, RDN, LD
• Tiffany Michelle Davasher
• Dave Ward Dental Center (Centerstone Dental Center)
• Jennifer Davenport, RECOVERY ASSISTANT
• Sydney Davenport, RN
• Charles S Davidson, MED.,ATC.,CSCS.,CEAS
• Haley Davidson

• Ambulatory Surgical Clinic/Center in Conway, AR
• Providers in Conway, AR by specialty
• Ambulatory Surgical Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.