1356482228 NPI number — ARKANSAS CARDIOVASCULAR SURGERY ASSOCIATES,P.A.

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 1356482228 NPI number — ARKANSAS CARDIOVASCULAR SURGERY ASSOCIATES,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS CARDIOVASCULAR SURGERY ASSOCIATES,P.A.
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:
ARKANSAS CARDIOVASCULAR SURGERY
Provider Other Organization Name Type Code:
5
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:
1356482228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 LILE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-6321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-224-5666
Provider Business Mailing Address Fax Number:
501-228-2007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 LILE DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-224-5666
Provider Business Practice Location Address Fax Number:
501-228-2007
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-224-5666

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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