Provider Demographics
NPI:1033404199
Name:JACK STEPHENS HEART INSTITUTE LLC
Entity Type:Organization
Organization Name:JACK STEPHENS HEART INSTITUTE LLC
Other - Org Name:ST. VINCENT CARDIOVASCULAR SURGEONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-552-3922
Mailing Address - Street 1:5 ST. VINCENT CIRCLE
Mailing Address - Street 2:STE 501
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5414
Mailing Address - Country:US
Mailing Address - Phone:501-666-2894
Mailing Address - Fax:501-666-9017
Practice Address - Street 1:5 ST. VINCENT CIRCLE
Practice Address - Street 2:STE 501
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5414
Practice Address - Country:US
Practice Address - Phone:501-666-2894
Practice Address - Fax:501-666-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty