Healthcare Provider Details

I. General information

NPI: 1326546672
Provider Name (Legal Business Name): ORTHOARKANSAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 LANDERS RD
NORTH LITTLE ROCK AR
72117-2541
US

IV. Provider business mailing address

3480 LANDERS RD
NORTH LITTLE ROCK AR
72117-2541
US

V. Phone/Fax

Practice location:
  • Phone: 501-978-3135
  • Fax: 501-978-3138
Mailing address:
  • Phone: 501-978-2623
  • Fax: 501-978-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMC1964
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACI FOX
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 501-500-3500