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Organization

FAYETTEVILLE SURGICAL ASSOC PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. GWEN S MATHIS (CLINIC ADMINISTRATOR)
(479) 521-3300
Entity
Organization

Contact information

Practice address
3264 N. NORTH HILLS BLVD., FAYETTEVILLE, AR 72703-4005
(479) 521-3300
(479) 521-4914
Mailing address
3264 N. NORTH HILLS BLVD., FAYETTEVILLE, AR 72703-4005
(479) 521-3300
(479) 521-4914

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
111799002
AR
Enumeration date
11/29/2006
Last updated
07/22/2013
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