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General NPI Number Information
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NPI Number | 1396727418
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY CENTER OF LITTLE ROCK,LLC
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 4200 N RODNEY PARHAM RD STE 203
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2460
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Country | US
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Telephone | 501-228-4445
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Fax | 501-228-0110
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Provider Business Mailing Address
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Address Line | 4200 N RODNEY PARHAM RD
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2460
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Country | US
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Telephone | 501-228-4445
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Fax | 501-228-0110
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ALISA PETET-MCELFRESH
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Credential | ADMINISTRATOR
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Telephone | 16-646-9805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | AR
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