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General NPI Number Information
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NPI Number | 1558337915
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Entity Type | Individual
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Provider Name | CAROL J. MCCOURT M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 1700 HARRISON ST SUITE T
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City | BATESVILLE
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State | AR
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Zip | 72501-7316
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Country | US
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Telephone | 870-262-6155
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Fax | 870-262-6512
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Provider Business Mailing Address
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Address Line | 1700 HARRISON ST SUITE T
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City | BATESVILLE
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State | AR
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Zip | 72501-7316
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Country | US
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Telephone | 870-262-6155
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Fax | 870-262-6512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD31930
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | E-8230
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License Number State | AR
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