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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