Healthcare Provider Details

I. General information

NPI: 1548253479
Provider Name (Legal Business Name): HARRISON CARDOLOGY CLINIC, P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N SPRING ST
HARRISON AR
72601-2937
US

IV. Provider business mailing address

PO BOX 2597
HARRISON AR
72602-2597
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-0761
  • Fax: 870-365-0763
Mailing address:
  • Phone: 870-365-0761
  • Fax: 870-365-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD E REVARD
Title or Position: PARTNER
Credential: MD
Phone: 870-365-0761