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Executive Park Surgery Center, LLC

Ambulatory Surgical Clinic/Center in Fort Smith, AR · enumerated 2006 · authorized official Randy Ennen, President.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1699736777

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Registry record

Entity type Organization (Type 2)
Legal business name Executive Park Surgery Center, LLC
Practice address 3314 S 70th St, Fort Smith, AR, 72903
Phone (479) 424-2744
Fax (479) 424-2745
Enumeration date Mar 29, 2006
Last updated in NPPES Dec 16, 2010

Taxonomy & classification

261QA1903X Ambulatory Surgical Clinic/Center Ambulatory Health Care Facilities Primary

Authorized official

Name Randy Ennen
Title President
Phone (479) 424-2744

Other identifiers

Identifier Type State Issuer
200041770A Medicaid OK -
155824128 Medicaid AR -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for Executive Park Surgery Center, LLC?
NPPES lists Randy Ennen (President) as the authorized official for this organization.
What is the NPI number for Executive Park Surgery Center, LLC?
The NPI for Executive Park Surgery Center, LLC is 1699736777, a Type 2 (organization) record in the CMS NPPES registry.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-12-16.