Provider Demographics
NPI:1972547099
Name:NEUROSURGERY ARKANSAS, PLLC
Entity type:Organization
Organization Name:NEUROSURGERY ARKANSAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MHH
Authorized Official - Phone:501-224-0200
Mailing Address - Street 1:9601 BAPTIST HEALTH DRIVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-224-0200
Mailing Address - Fax:501-224-2292
Practice Address - Street 1:9601 BAPTIST HEALTH DRIVE
Practice Address - Street 2:SUITE 750
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-224-0200
Practice Address - Fax:501-224-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7182611OtherAETNA
AR155462002Medicaid
ARDC5711Medicare PIN
AR5F185Medicare PIN