Provider Demographics
NPI:1043625221
Name:INTERVENTIONAL SURGERY INSTITUTE OF LITTLE ROCK, LLC
Entity type:Organization
Organization Name:INTERVENTIONAL SURGERY INSTITUTE OF LITTLE ROCK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-346-8116
Mailing Address - Street 1:108 N. SHACKLEFORD ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-346-8116
Mailing Address - Fax:501-771-4885
Practice Address - Street 1:9 FREEWAY DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:844-215-0731
Practice Address - Fax:501-404-9625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APTA HOLDINGS II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-25
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR208454128Medicaid