Provider Demographics
NPI:1558337915
Name:MCCOURT, CAROL J (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HARRISON ST
Mailing Address - Street 2:SUITE T
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7316
Mailing Address - Country:US
Mailing Address - Phone:870-262-6155
Mailing Address - Fax:870-262-6512
Practice Address - Street 1:1700 HARRISON ST
Practice Address - Street 2:SUITE T
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7316
Practice Address - Country:US
Practice Address - Phone:870-262-6155
Practice Address - Fax:870-262-6512
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31930207L00000X
ARE-8230207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH02408Medicare UPIN
TN103I050605Medicare PIN