Provider Demographics
NPI:1588408033
Name:PREMIER RURAL DB & GANTT SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PREMIER RURAL DB & GANTT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIAN
Authorized Official - Middle Name:IMRAN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-875-1481
Mailing Address - Street 1:403 W. OAK STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4573
Mailing Address - Country:US
Mailing Address - Phone:870-875-1481
Mailing Address - Fax:870-875-1486
Practice Address - Street 1:403 W. OAK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4573
Practice Address - Country:US
Practice Address - Phone:870-875-1481
Practice Address - Fax:870-875-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical