Provider Demographics
NPI:1912908492
Name:ARKANSAS HEART CENTER, PLC
Entity Type:Organization
Organization Name:ARKANSAS HEART CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-484-1010
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1768
Mailing Address - Country:US
Mailing Address - Phone:479-484-1010
Mailing Address - Fax:479-785-9916
Practice Address - Street 1:4200 JENNY LIND RD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7660
Practice Address - Country:US
Practice Address - Phone:479-484-1010
Practice Address - Fax:479-785-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1808261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134133002Medicaid
AR5C012Medicare ID - Type Unspecified
AR134133002Medicaid