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General NPI Number Information
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NPI Number | 1073688511
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Entity Type | Organization
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Legal Business Name | HEART ASSOCIATES OF SOUTH ARKANSAS, INC.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 619 W GROVE ST
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City | EL DORADO
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State | AR
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Zip | 71730-4413
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Country | US
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Telephone | 870-863-6133
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Fax | 870-863-6290
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Provider Business Mailing Address
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Address Line | 619 W GROVE ST
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City | EL DORADO
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State | AR
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Zip | 71730-4413
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Country | US
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Telephone | 870-863-6133
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Fax | 870-863-6290
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALDO V FONTICIELLA
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Credential | MD
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Telephone | 870-866-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | E0097
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License Number State | AR
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