Healthcare Provider Details

I. General information

NPI: 1730511387
Provider Name (Legal Business Name): ARKANSAS ORTHOPEDIC SURGERY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MEDICAL PARK PL SUITE 101
HOT SPRINGS AR
71901-8065
US

IV. Provider business mailing address

180 MEDICAL PARK PL SUITE 101
HOT SPRINGS AR
71901-8065
US

V. Phone/Fax

Practice location:
  • Phone: 501-620-4825
  • Fax: 501-620-4899
Mailing address:
  • Phone: 501-620-4825
  • Fax: 501-620-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE2959
License Number StateAR

VIII. Authorized Official

Name: DR. JAMES KEVIN RUDDER
Title or Position: AMINISTRATOR/PHYSICIAN
Credential: MD
Phone: 501-620-4825