MEDICARE: MR. RICHARD TIMOTHY EVANS BSCCT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246X00000X	Cardiovascular Specialist/Technologist

General Provider Information

NPI Number	:	1649413949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD TIMOTHY EVANS BSCCT

Provider Business Mailing Address
First Line	:	1 INNWOOD CIR
Second Line	:	STE 102
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2447
Country	:	US
Telephone Number	:	501-217-8200
Fax Number	:	501-217-8201

Provider Business Practice Location Address
First Line	:	1 INNWOOD CIR
Second Line	:	STE 102
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2447
Country	:	US
Telephone Number	:	501-217-8200
Fax Number	:	501-217-8201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/16/2009

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