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General NPI Number Information
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NPI Number | 1295886026
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Entity Type | Organization
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Legal Business Name | RICCA NEUROSURGICAL CLINIC PLLC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 701 WINDOVER ROAD SUITE 400
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-336-2100
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Fax | 870-336-2101
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Provider Business Mailing Address
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Address Line | 701 WINDOVER ROAD SUITE 400
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-336-2100
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Fax | 870-336-2101
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Authorized Official
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Title or Position | MEMBER
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Name | DR. GREGORY F. RICCA
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Credential | MD
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Telephone | 870-336-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MC2473
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License Number State | AR
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