Organization
LITTLE ROCK CANCER CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS REYES (OFFICE MANAGER)
(501) 661-1822
Entity
Organization
Contact information
Practice address
500 S UNIVERSITY AVE, SUITE 811, LITTLE ROCK, AR 72205-5302
(501) 661-1822
(501) 666-0266
Mailing address
500 S UNIVERSITY AVE STE 606, LITTLE ROCK, AR 72205-5308
(501) 661-1822
(501) 666-0266
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04D0922485
C.L.I.A. NUMBER FOR LAB
—
05
—
130483002
—
AR
01
—
1902832330
MERCY HEALTH PLANS
—
01
—
472130
HEALTHLINK PPO
—
01
—
5239121
AETNA
—
Enumeration date
06/25/2006
Last updated
01/13/2020
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