MEDICARE: ARKANSAS VASCULAR SURGERY, PLLC

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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1235778515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS VASCULAR SURGERY, PLLC

Provider Business Mailing Address
First Line	:	11300 N RODNEY PARHAM RD STE 210
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4149
Country	:	US
Telephone Number	:	501-313-1001
Fax Number	:	501-663-4145

Provider Business Practice Location Address
First Line	:	11300 N RODNEY PARHAM RD STE 210
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4149
Country	:	US
Telephone Number	:	501-251-7787
Fax Number	:

Authorized Official
Title or Position	:	OWNER/VASCULAR SURGEON
Name	:	DR. SCOTT JAMES RYAN
Credential	:	MD
Telephone Number	:	501-251-7787

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	02/10/2020

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