Provider Demographics
NPI:1124504030
Name:INTERVENTIONAL CELLULAR MEDICINE CENTERS, LLC
Entity type:Organization
Organization Name:INTERVENTIONAL CELLULAR MEDICINE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARSHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-422-7600
Mailing Address - Street 1:774 E WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3461
Mailing Address - Country:US
Mailing Address - Phone:479-422-7600
Mailing Address - Fax:
Practice Address - Street 1:593 HORSEBARN ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7275
Practice Address - Country:US
Practice Address - Phone:479-271-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty