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General NPI Number Information
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NPI Number | 1861488587
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Entity Type | Organization
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Legal Business Name | LITTLE ROCK OUTPATIENT SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 8907 KANIS RD STE. 100
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6449
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Country | US
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Telephone | 501-217-9007
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Fax | 501-221-0337
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Provider Business Mailing Address
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Address Line | 8907 KANIS RD STE. 100
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6449
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Country | US
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Telephone | 501-217-9007
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Fax | 501-221-0337
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JERRY KINCAID
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Credential |
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Telephone | 501-217-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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