Organization
ADVANCED AMBULATORY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE BRANDON HENRY M.D. (DIRECTOR)
(479) 568-8494
Entity
Organization
Contact information
Practice address
1444 E STEARNS ST, SUITE 15, FAYETTEVILLE, AR 72703-6243
(479) 966-4972
(479) 966-4655
Mailing address
1444 E STEARNS ST, SUITE 15, FAYETTEVILLE, AR 72703-6243
(479) 966-4972
(479) 966-4655
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
478741
JACHO
—
01
—
AR4579
STATE OF ARKANSAS DEPARTMENT OF HEALTH
AR
Enumeration date
11/07/2007
Last updated
08/29/2012
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