Healthcare Provider Details

I. General information

NPI: 1518752849
Provider Name (Legal Business Name): CARDIAC IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 GRISHAM RD
ROYAL AR
71968-9565
US

IV. Provider business mailing address

PO BOX 377
ROYAL AR
71968-0377
US

V. Phone/Fax

Practice location:
  • Phone: 501-276-6557
  • Fax:
Mailing address:
  • Phone: 501-276-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MCCLELLAN
Title or Position: PRESIDENT
Credential: RVS RCS
Phone: 501-276-6557