Provider Demographics
NPI:1306882790
Name:SOUTH ARKANSAS DIAGNOSTIC CLINIC
Entity type:Organization
Organization Name:SOUTH ARKANSAS DIAGNOSTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-862-5732
Mailing Address - Street 1:403 W OAK ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-5732
Mailing Address - Fax:870-863-8802
Practice Address - Street 1:403 W OAK ST
Practice Address - Street 2:SUITE 303
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-862-5732
Practice Address - Fax:870-863-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4488207R00000X
ARA01412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D04602Medicare UPIN
P44544Medicare UPIN
52111Medicare ID - Type Unspecified
5U639Medicare ID - Type Unspecified