Provider Demographics
NPI:1982844114
Name:CARDIOLOGY CARE OF SOUTH ARKANSAS, INC
Entity Type:Organization
Organization Name:CARDIOLOGY CARE OF SOUTH ARKANSAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:870-862-8700
Mailing Address - Street 1:704 S TIMBERLANE DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6929
Mailing Address - Country:US
Mailing Address - Phone:870-862-8700
Mailing Address - Fax:870-862-8703
Practice Address - Street 1:704 S TIMBERLANE DR
Practice Address - Street 2:SUITE 12
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6929
Practice Address - Country:US
Practice Address - Phone:870-862-8700
Practice Address - Fax:870-862-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03003261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center