Healthcare Provider Details

I. General information

NPI: 1497267702
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF ARKANSAS ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 NATURAL RESOURCES DR
LITTLE ROCK AR
72205-1573
US

IV. Provider business mailing address

PO BOX 291832
NASHVILLE TN
37229-1832
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT ROBERTS
Title or Position: COO
Credential:
Phone: 615-620-2324