Provider Demographics
NPI:1649207861
Name:ARKANSAS CARDIOVASCULAR ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ARKANSAS CARDIOVASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:501-663-6391
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 711
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-663-6391
Mailing Address - Fax:501-663-6978
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 711
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-663-6391
Practice Address - Fax:501-663-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8271207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146873001Medicaid
AR060070984OtherRAILROAD
AR2500177OtherUHC
AR195920002Medicaid
AR5F666OtherBCBS
7236050OtherAETNA
03010013300OtherQC
AR060070984OtherRAILROAD
AR5F666OtherBCBS