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NPI Code Detail

MEDICARE: HEART CLINIC ARKANSAS

MEDICARE: HEART CLINIC ARKANSAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
204D0978456OTHERARCLIA NUMBER-KANIS

General Provider Information

NPI Number : 1053367508
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEART CLINIC ARKANSAS
Provider Business Mailing Address
First Line : 10100 KANIS RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6202
Country : US
Telephone Number : 501-255-6000
Fax Number : 501-255-6400
Provider Business Practice Location Address
First Line : 10100 KANIS RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6202
Country : US
Telephone Number : 501-255-6000
Fax Number : 501-255-6400
Authorized Official
Title or Position : PRESIDENT
Name : MR. RANDY A JORDAN
Credential : M.D.
Telephone Number : 501-255-6000
Provider Enumeration Date : 05/26/2006
Last Update Date : 01/21/2011

Similar Medicare Providers

1245215243 — DR. PRABHAT K HEBBAR M.D.
Practice Location Address:
10100 KANIS RD
LITTLE ROCK, AR
72205-6202
Practice Phone: 501-255-6000
Practice Fax: 501-255-6400
1073576625 — YALCIN HACIOGLU M.D.
Practice Location Address:
10100 KANIS RD
LITTLE ROCK, AR
72205-6202
Practice Phone: 501-255-6000
Practice Fax: 501-255-6409
1619939220 — THOMAS H HOFFMANN MD
Practice Location Address:
10100 KANIS RD
LITTLE ROCK, AR
72205-6202
Practice Phone: 501-255-6000
Practice Fax: 501-255-6411
1962449728 — DR. CHARLES W CLOGSTON M.D.
Practice Location Address:
10100 KANIS RD
LITTLE ROCK, AR
72205-6202
Practice Phone: 501-255-6000
Practice Fax: 501-255-6400
1447297320 — KRISTIE N CRONKHITE ANP
Practice Location Address:
10100 KANIS RD
LITTLE ROCK, AR
72205-6202
Practice Phone: 501-255-6000
Practice Fax: 501-255-6400
1629017587 — SAMUEL THOMAS RAYBURN M.D.
Practice Location Address:
10100 KANIS RD
LITTLE ROCK, AR
72205-6202
Practice Phone: 501-223-5757
Practice Fax: 501-223-5758

Directions to “HEART CLINIC ARKANSAS ” Practice Location

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