Organization
CARDIOLOGY AND MEDICINE CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA FERGUSON SMITH (CLINIC ADMINISTRATOR)
(501) 664-0941
Entity
Organization
Contact information
Practice address
5315 W 12TH ST, LITTLE ROCK, AR 72204-1858
(501) 664-0941
(501) 666-3956
Mailing address
5315 W 12TH ST, LITTLE ROCK, AR 72204-1858
(501) 664-0941
(501) 666-3956
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145330002
—
AR
01
—
5B371
BLUE CROSS/BLUE SHIELD
AR
01
—
D9086
RAILROAD MEDICARE
—
Enumeration date
09/08/2005
Last updated
07/18/2012
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