Provider Demographics
NPI:1730511387
Name:ARKANSAS ORTHOPEDIC SURGERY AND WELLNESS CENTER
Entity type:Organization
Organization Name:ARKANSAS ORTHOPEDIC SURGERY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMINISTRATOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:RUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-620-4825
Mailing Address - Street 1:180 MEDICAL PARK PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8065
Mailing Address - Country:US
Mailing Address - Phone:501-620-4825
Mailing Address - Fax:501-620-4899
Practice Address - Street 1:180 MEDICAL PARK PL
Practice Address - Street 2:SUITE 101
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8065
Practice Address - Country:US
Practice Address - Phone:501-620-4825
Practice Address - Fax:501-620-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2959207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty