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General NPI Number Information
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NPI Number | 1982844114
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY CARE OF SOUTH ARKANSAS, INC
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 704 S TIMBERLANE DR SUITE 12
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City | EL DORADO
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State | AR
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Zip | 71730-6929
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Country | US
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Telephone | 870-862-8700
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Fax | 870-862-8703
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Provider Business Mailing Address
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Address Line | 704 S TIMBERLANE DR SUITE 12
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City | EL DORADO
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State | AR
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Zip | 71730-6929
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Country | US
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Telephone | 870-862-8700
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Fax | 870-862-8703
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. ANGELA CHRISTINE SIMMONS
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Credential | APN
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Telephone | 870-862-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A03003
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License Number State | AR
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