Provider Demographics
NPI:1396897260
Name:LITTLE ROCK FERTILITY CENTER
Entity type:Organization
Organization Name:LITTLE ROCK FERTILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUMPHRIESH
Authorized Official - Suffix:
Authorized Official - Credentials:MNSC
Authorized Official - Phone:501-801-1200
Mailing Address - Street 1:9101 KANIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6417
Mailing Address - Country:US
Mailing Address - Phone:501-801-1200
Mailing Address - Fax:501-801-1207
Practice Address - Street 1:9101 KANIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6417
Practice Address - Country:US
Practice Address - Phone:501-801-1200
Practice Address - Fax:501-801-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4372261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR4372OtherSTATE FACILITY LICENSE