Provider Demographics
NPI:1336178177
Name:CARDIO THORACIC SURGEONS OF NEA
Entity Type:Organization
Organization Name:CARDIO THORACIC SURGEONS OF NEA
Other - Org Name:CARDIOTHORACIC SURGEONS OF NEA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RNP, MBA
Authorized Official - Phone:870-935-6729
Mailing Address - Street 1:201 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4163
Mailing Address - Country:US
Mailing Address - Phone:870-935-6729
Mailing Address - Fax:870-268-4408
Practice Address - Street 1:201 E OAK AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4163
Practice Address - Country:US
Practice Address - Phone:870-935-6729
Practice Address - Fax:870-268-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152254002Medicaid
AR152254002Medicaid