Organization
YOUR BARIATRIC CARE CLINIC EA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE RUCKS (OFFICE MANAGER)
(501) 663-9600
Entity
Organization
Contact information
Practice address
1 SAINT VINCENT CIR STE 320, LITTLE ROCK, AR 72205-5408
(501) 663-9600
(501) 217-8502
Mailing address
1 SAINT VINCENT CIR STE 320, LITTLE ROCK, AR 72205-5408
(501) 663-9600
(501) 217-8502
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
C-7393
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558330431
NPI
AR
Enumeration date
05/21/2018
Last updated
05/21/2018
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