Healthcare Provider Details

I. General information

NPI: 1861488587
Provider Name (Legal Business Name): LITTLE ROCK OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 KANIS RD STE. 100
LITTLE ROCK AR
72205-6449
US

IV. Provider business mailing address

8907 KANIS RD STE. 100
LITTLE ROCK AR
72205-6449
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-9007
  • Fax: 501-221-0337
Mailing address:
  • Phone: 501-217-9007
  • Fax: 501-221-0337

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: MR. JERRY KINCAID
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-217-9007