Healthcare Provider Details

I. General information

NPI: 1295120459
Provider Name (Legal Business Name): CAVC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11771 MAUMELLE BLVD
NORTH LITTLE ROCK AR
72113-6558
US

IV. Provider business mailing address

PO BOX 17930
LITTLE ROCK AR
72222-7930
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-9803
  • Fax: 501-321-0710
Mailing address:
  • Phone: 501-663-0490
  • Fax: 501-663-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAN M SUTTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-663-0490