OrganizationActive
Executive Park Surgery Center, LLC
NPI 1699736777 · Ambulatory Surgical Clinic/Center · Fort Smith, AR
Provider details
- NPI number
- 1699736777
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Randy Ennen, President(479) 424-2744
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3314 S 70th St
Fort Smith, AR 72903-5052
Phone: (479) 424-2744
Fax: (479) 424-2745
Street-level locationGet directions
Mailing address
3314 S 70th St
Fort Smith, AR 72903-5052
Registry dates
- Enumerated
- 2006-03-29
- Last updated
- 2010-12-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.