Provider Demographics
NPI:1922570407
Name:FOOT & ANKLE CENTER OF LITTLE ROCK, PLLC
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER OF LITTLE ROCK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NINI
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-442-5207
Mailing Address - Street 1:10020 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2130
Mailing Address - Country:US
Mailing Address - Phone:501-221-2266
Mailing Address - Fax:501-224-5660
Practice Address - Street 1:10020 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2130
Practice Address - Country:US
Practice Address - Phone:501-221-2266
Practice Address - Fax:501-224-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206324748Medicaid
AR204785717Medicaid