Provider Demographics
NPI:1437110293
Name:ST. VINCENT-ARKANSAS ORTHOPAEDIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:ST. VINCENT-ARKANSAS ORTHOPAEDIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-978-2600
Mailing Address - Street 1:6119 MIDTOWN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-553-9827
Mailing Address - Fax:501-553-9836
Practice Address - Street 1:6119 MIDTOWN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-553-9827
Practice Address - Fax:501-553-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3608261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR3608OtherLICENSE NO.
AR135319128Medicaid
ARAR3608OtherLICENSE NO.