MEDICARE: MISSION PROPERTIES GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1194299289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION PROPERTIES GROUP, LLC

Provider Business Mailing Address
First Line	:	12 SPRING VALLEY LN
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-4494
Country	:	US
Telephone Number	:	501-399-4212
Fax Number	:	501-868-7551

Provider Business Practice Location Address
First Line	:	11220 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4492
Country	:	US
Telephone Number	:	501-399-4212
Fax Number	:	501-868-7551

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VAN H DE BRUYN
Credential	:	MD
Telephone Number	:	501-399-4212

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	03/06/2020

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Directions to “MISSION PROPERTIES GROUP, LLC ” Practice Location

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