Healthcare Provider Details

I. General information

NPI: 1093799405
Provider Name (Legal Business Name): ORTHOARKANSAS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 KANIS RD
LITTLE ROCK AR
72205-6205
US

IV. Provider business mailing address

10301 KANIS RD
LITTLE ROCK AR
72205-6205
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-4150
  • Fax: 501-604-4127
Mailing address:
  • Phone: 501-604-4150
  • Fax: 501-604-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAR3758
License Number StateAR

VIII. Authorized Official

Name: MS. GRETCHEN MARCHESE
Title or Position: FINANCIAL MANAGER
Credential: CPC
Phone: 501-604-4150