Healthcare Provider Details

I. General information

NPI: 1093720443
Provider Name (Legal Business Name): ARKANSAS UROLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CENTERVIEW DR
LITTLE ROCK AR
72211-4349
US

IV. Provider business mailing address

1300 CENTERVIEW DR
LITTLE ROCK AR
72211-4349
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-8900
  • Fax: 501-537-1875
Mailing address:
  • Phone: 501-219-8900
  • Fax: 501-537-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1117630001
License Number StateAR

VIII. Authorized Official

Name: DENISE LYNN BELFORD
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 501-219-8900