Organization Active NPI

Little Rock Diagnostic Clinic PA

  • Internal Medicine Physician
  • Little Rock, AR
National Provider Identifier
1497784854
Registry record updated Nov 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LITTLE ROCK DIAGNOSTIC CLINIC PA
Practice address
10001 Lile Dr
Little Rock, AR 72205-6217
Phone
(501) 227-8000
Fax
(501) 221-5895
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Jackson
Title
Quality Manager
Phone
(501) 227-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

10001 Lile Dr
Little Rock, AR 72205-6217

Mailing address

10001 Lile Dr
Little Rock, AR 72205-6217
Phone (501) 227-8000

Other identifiers 1

IdentifierTypeStateIssuer
104282002MedicaidAR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510099200000",
    "number": "1497784854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 LILE DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056217",
            "telephone_number": "501-227-8000",
            "fax_number": "501-221-5895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10001 LILE DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056217",
            "telephone_number": "501-227-8000",
            "fax_number": "501-221-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE ROCK DIAGNOSTIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2017-11-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "QUALITY MANAGER",
        "authorized_official_telephone_number": "501-227-8000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104282002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.