Healthcare Provider Details

I. General information

NPI: 1043625221
Provider Name (Legal Business Name): INTERVENTIONAL SURGERY INSTITUTE OF LITTLE ROCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 FREEWAY DRIVE SUITE A
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

108 N. SHACKLEFORD ROAD SUITE 200
LITTLE ROCK AR
72211
US

V. Phone/Fax

Practice location:
  • Phone: 844-215-0731
  • Fax: 501-404-9625
Mailing address:
  • Phone: 501-346-8116
  • Fax: 501-771-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MCCRARY
Title or Position: CEO
Credential:
Phone: 501-346-8116