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Organization
LITTLE ROCK DIAGNOSTIC CLINIC PA
Active
Organization
LITTLE ROCK DIAGNOSTIC CLINIC PA
Active
Other names
Little Rock Diagnostic Clinic ASC
Organization subpart
No
Provider details
NPI number
Authorized official
DARLENE CAROL HEBDA (CREDENTIALING COORDINATOR)
(501) 223-4543
Entity
Organization
Contact information
Practice address
10001 LILE DR, LITTLE ROCK, AR 72205-6217
(501) 227-8000
(501) 221-5895
Mailing address
10001 LILE DR, LITTLE ROCK, AR 72205-6217
(501) 227-8000
(501) 221-5895
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122223128
—
AR
Enumeration date
06/23/2006
Last updated
03/07/2018
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