Provider Demographics
NPI:1659340404
Name:LITTLE ROCK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LITTLE ROCK SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMMA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:501-224-6767
Mailing Address - Street 1:8820 KNOEDL CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4600
Mailing Address - Country:US
Mailing Address - Phone:501-224-6767
Mailing Address - Fax:501-224-8203
Practice Address - Street 1:8820 KNOEDL CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4600
Practice Address - Country:US
Practice Address - Phone:501-224-6767
Practice Address - Fax:501-224-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2638261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11006Medicare PIN