Organization
LITTLE ROCK OUTPATIENT SURGERY CENTER, LLC
Active
Other names
Rivercrest Specialty Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY KINCAID (ADMINISTRATOR)
(501) 217-9007
Entity
Organization
Contact information
Practice address
8907 KANIS RD, STE. 100, LITTLE ROCK, AR 72205-6449
(501) 217-9007
(501) 221-0337
Mailing address
8907 KANIS RD, STE. 100, LITTLE ROCK, AR 72205-6449
(501) 217-9007
(507) 221-0337
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AR4172
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11039
BCBS
AR
05
—
135696128
—
AR
Enumeration date
09/27/2005
Last updated
07/09/2008
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