Healthcare Provider Details

I. General information

NPI: 1366489247
Provider Name (Legal Business Name): BIB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 EXECUTIVE CENTER DR SUITE 200
LITTLE ROCK AR
72211-4316
US

IV. Provider business mailing address

829 W CARPENTER ST
BENTON AR
72015-3349
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-7587
  • Fax: 501-812-7588
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE TODD HECK
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 501-202-4000