Healthcare Provider Details

I. General information

NPI: 1639908759
Provider Name (Legal Business Name): SYNERGY HEALTHCARE LITTLE ROCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 W MARKHAM ST
LITTLE ROCK AR
72205-5530
US

IV. Provider business mailing address

PO BOX 20059
HOT SPRINGS AR
71903-0059
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-1000
  • Fax: 501-762-8299
Mailing address:
  • Phone: 501-623-4000
  • Fax: 501-762-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BUKOWSKI
Title or Position: PRESIDENT
Credential:
Phone: 501-623-4000