Healthcare Provider Details

I. General information

NPI: 1265189948
Provider Name (Legal Business Name): PAD SPECIALISTS - LITTLE ROCK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 CHENAL PKWY STE 102
LITTLE ROCK AR
72211-5260
US

IV. Provider business mailing address

P.O. BOX 737373
DALLAS TX
75373-7373
US

V. Phone/Fax

Practice location:
  • Phone: 281-888-8999
  • Fax: 281-305-4054
Mailing address:
  • Phone: 281-888-8999
  • Fax: 281-305-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW EKANSH GOMES
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 281-888-8999