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General NPI Number Information
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NPI Number | 1649207861
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Entity Type | Organization
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Legal Business Name | ARKANSAS CARDIOVASCULAR ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE SUITE 711
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-663-6391
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Fax | 501-663-6978
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE SUITE 711
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-663-6391
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Fax | 501-663-6978
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOSES KELLEY III
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Credential | M.D.
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Telephone | 501-663-6391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | C-8271
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License Number State | AR
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