MEDICARE: LITTLE ROCK RENAL SERVICES 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1609291202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ROCK RENAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1633 CHURCH ST
Second Line	:	SUITE 500
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2990
Country	:	US
Telephone Number	:	615-327-3061
Fax Number	:	615-329-2513

Provider Business Practice Location Address
First Line	:	1910 JOHN BARROW RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1448
Country	:	US
Telephone Number	:	501-227-0983
Fax Number	:	501-227-0974

Authorized Official
Title or Position	:	PRESIDENT OF MEMBER
Name	:	WILLIAM E WOOD II
Credential	:
Telephone Number	:	615-327-3061

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	07/15/2019

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