1407949555 NPI number — ARRHYTHMIA ASSOCIATES OF NEA, LLC

Table of content: (NPI 1407949555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407949555 NPI number — ARRHYTHMIA ASSOCIATES OF NEA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARRHYTHMIA ASSOCIATES OF NEA, 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:
CORECARE MEDICAL GROUP
Provider Other Organization Name Type Code:
3
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:
1407949555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72403-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-316-1016
Provider Business Mailing Address Fax Number:
870-292-3535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 VIRGINIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72501-7329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-316-1016
Provider Business Practice Location Address Fax Number:
870-292-3535
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
870-761-4426

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MC2533 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 180083001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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