Healthcare Provider Details

I. General information

NPI: 1982637278
Provider Name (Legal Business Name): SPECIALTY PRACTICE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 POINSETTA DR
LITTLE ROCK AR
72205-2251
US

IV. Provider business mailing address

319 POINSETTA DR P.O. BOX 55990
LITTLE ROCK AR
72205-2251
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-0700
  • Fax:
Mailing address:
  • Phone: 501-227-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAULA KEYS
Title or Position: MANAGER
Credential:
Phone: 501-227-0700