Healthcare Provider Details

I. General information

NPI: 1609399963
Provider Name (Legal Business Name): INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 DOLLARWAY ROAD
WHITE HALL AR
71602
US

IV. Provider business mailing address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
US

V. Phone/Fax

Practice location:
  • Phone: 501-773-6993
  • Fax:
Mailing address:
  • Phone: 501-773-6993
  • Fax:

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: WILLIAM W MCCRARY
Title or Position: CEO
Credential:
Phone: 501-346-8116