Provider Demographics
NPI:1154342467
Name:CENTRAL ARKANSAS CARDIOLOGY
Entity type:Organization
Organization Name:CENTRAL ARKANSAS CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-758-3999
Mailing Address - Street 1:4000 RICHARDS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2650
Mailing Address - Country:US
Mailing Address - Phone:501-758-3999
Mailing Address - Fax:501-758-8653
Practice Address - Street 1:4000 RICHARDS RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2650
Practice Address - Country:US
Practice Address - Phone:501-758-3999
Practice Address - Fax:501-758-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B060Medicare ID - Type Unspecified