Provider Demographics
NPI:1073688511
Name:HEART ASSOCIATES OF SOUTH ARKANSAS, INC.
Entity Type:Organization
Organization Name:HEART ASSOCIATES OF SOUTH ARKANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:V
Authorized Official - Last Name:FONTICIELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-866-9450
Mailing Address - Street 1:619 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4413
Mailing Address - Country:US
Mailing Address - Phone:870-863-6133
Mailing Address - Fax:870-863-6290
Practice Address - Street 1:619 W GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4413
Practice Address - Country:US
Practice Address - Phone:870-863-6133
Practice Address - Fax:870-863-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0097207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C008OtherBCBS
AR125598001Medicaid
ARE86991Medicare UPIN