Healthcare Provider Details

I. General information

NPI: 1699333104
Provider Name (Legal Business Name): CENTRAL ARKANSAS INFUSION SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 KANIS RD STE 403
LITTLE ROCK AR
72205-6400
US

IV. Provider business mailing address

2613 JOHNSWOOD VILLAGE DR
BRYANT AR
72022-2759
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-1692
  • Fax:
Mailing address:
  • Phone: 501-920-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW BRIKHA
Title or Position: OWNER
Credential:
Phone: 501-920-2505