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Organization
EXECUTIVE SURGERY CENTER OF LITTLE ROCK, LLC
Active
Organization
EXECUTIVE SURGERY CENTER OF LITTLE ROCK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRITNEY DESHAE SMITH RN (ADMINISTRATOR)
(501) 312-2121
Entity
Organization
Contact information
Practice address
11220 EXECUTIVE CENTER DR, SUITE 100, LITTLE ROCK, AR 72211-4320
(501) 312-2121
(501) 312-2330
Mailing address
11220 EXECUTIVE CENTER DR, SUITE 100, LITTLE ROCK, AR 72211-4320
(501) 312-2121
(501) 312-2330
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225821128
—
AR
01
—
3130254
FIRST HEALTH
—
01
—
6098850
AETNA
—
01
—
970544
AETNA COVENTRY
—
Enumeration date
04/06/2017
Last updated
10/13/2020
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