Healthcare Provider Details

I. General information

NPI: 1881614642
Provider Name (Legal Business Name): CARDIAC & VASCULAR CENTER OF ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S HAZEL ST
PINE BLUFF AR
71603-7836
US

IV. Provider business mailing address

7200 S HAZEL ST
PINE BLUFF AR
71603-7836
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-2900
  • Fax: 870-534-5323
Mailing address:
  • Phone: 870-534-2900
  • Fax: 870-534-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMC1682
License Number StateAR

VIII. Authorized Official

Name: DR. SHABBIR DHARAMSEY
Title or Position: OWNER
Credential: M.D.
Phone: 870-534-2900