Healthcare Provider Details

I. General information

NPI: 1194299289
Provider Name (Legal Business Name): MISSION PROPERTIES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4492
US

IV. Provider business mailing address

12 SPRING VALLEY LN
LITTLE ROCK AR
72223-4494
US

V. Phone/Fax

Practice location:
  • Phone: 501-399-4212
  • Fax: 501-868-7551
Mailing address:
  • Phone: 501-399-4212
  • Fax: 501-868-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VAN H DE BRUYN
Title or Position: OWNER
Credential: MD
Phone: 501-399-4212