Healthcare Provider Details

I. General information

NPI: 1306695747
Provider Name (Legal Business Name): LITTLE ROCK INFUSION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 CHENAL PKWY STE 100
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

15200 CHENAL PKWY STE 100
LITTLE ROCK AR
72211
US

V. Phone/Fax

Practice location:
  • Phone: 501-451-6080
  • Fax: 501-451-6081
Mailing address:
  • Phone: 501-451-6080
  • Fax: 501-451-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: WILLAM A. HEGI
Title or Position: OWNER
Credential:
Phone: 501-451-6080