1639908759 NPI number — SYNERGY HEALTHCARE LITTLE ROCK LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639908759 NPI number — SYNERGY HEALTHCARE LITTLE ROCK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY HEALTHCARE LITTLE ROCK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639908759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20059
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71903-0059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-623-4000
Provider Business Mailing Address Fax Number:
501-762-8299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4024 W MARKHAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-5530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-664-1000
Provider Business Practice Location Address Fax Number:
501-762-8299
Provider Enumeration Date:
07/29/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BUKOWSKI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-623-4000

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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