Provider Demographics
NPI:1558653212
Name:ARKANSAS HEART HOSPITAL, LLC
Entity Type:Organization
Organization Name:ARKANSAS HEART HOSPITAL, LLC
Other - Org Name:ARKANSAS HEART HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-219-7000
Mailing Address - Street 1:7 SHACKLEFORD WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3714
Mailing Address - Country:US
Mailing Address - Phone:501-614-3671
Mailing Address - Fax:501-663-5017
Practice Address - Street 1:7 SHACKLEFORD WEST BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3714
Practice Address - Country:US
Practice Address - Phone:501-664-5860
Practice Address - Fax:501-664-0889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AR-MED, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3195207RC0000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
040134Medicare Oscar/Certification