Healthcare Provider Details

I. General information

NPI: 1609291202
Provider Name (Legal Business Name): LITTLE ROCK RENAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 JOHN BARROW RD
LITTLE ROCK AR
72204-1448
US

IV. Provider business mailing address

1633 CHURCH ST SUITE 500
NASHVILLE TN
37203-2990
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-0983
  • Fax: 501-227-0974
Mailing address:
  • Phone: 615-327-3061
  • Fax: 615-329-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM E WOOD II
Title or Position: PRESIDENT OF MEMBER
Credential:
Phone: 615-327-3061