Provider Demographics
NPI:1124346739
Name:LITTLE ROCK GYNECOLOGY & OBSTETRICS PLLC
Entity type:Organization
Organization Name:LITTLE ROCK GYNECOLOGY & OBSTETRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-221-9700
Mailing Address - Street 1:9501 LILE DRIVE
Mailing Address - Street 2:SUITE 770
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6227
Mailing Address - Country:US
Mailing Address - Phone:501-221-9700
Mailing Address - Fax:501-221-3239
Practice Address - Street 1:9501 LILE DRIVE
Practice Address - Street 2:SUITE 770
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6227
Practice Address - Country:US
Practice Address - Phone:501-221-9700
Practice Address - Fax:501-221-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AR174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1710008784OtherINDIVIDUAL NPI
AR1952422925OtherINDIVIDUAL NPI
AR184318002Medicaid