Healthcare Provider Details

I. General information

NPI: 1215919329
Provider Name (Legal Business Name): GASTRO-INTESTINAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N UNIVERSITY AVE
LITTLE ROCK AR
72205-3108
US

IV. Provider business mailing address

405 N UNIVERSITY AVE
LITTLE ROCK AR
72205-3108
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-1074
  • Fax: 501-663-0906
Mailing address:
  • Phone: 501-663-1074
  • Fax: 501-663-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRETT A KIRKMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 501-664-2727