Provider Demographics
NPI:1982715074
Name:LITTLE ROCK SPINE & JOINT CLINIC
Entity Type:Organization
Organization Name:LITTLE ROCK SPINE & JOINT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:KIZZIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-785-0612
Mailing Address - Street 1:1401 SOUTH J. STREET
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5158
Mailing Address - Country:US
Mailing Address - Phone:479-785-0612
Mailing Address - Fax:479-785-8598
Practice Address - Street 1:1401 SOUTH J. STREET
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5158
Practice Address - Country:US
Practice Address - Phone:479-785-0612
Practice Address - Fax:479-785-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8478261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5J834Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #