Provider Demographics
NPI:1548253479
Name:HARRISON CARDOLOGY CLINIC, P A
Entity type:Organization
Organization Name:HARRISON CARDOLOGY CLINIC, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:REVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-365-0761
Mailing Address - Street 1:PO BOX 2597
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-2597
Mailing Address - Country:US
Mailing Address - Phone:870-365-0761
Mailing Address - Fax:870-365-0763
Practice Address - Street 1:702 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2937
Practice Address - Country:US
Practice Address - Phone:870-365-0761
Practice Address - Fax:870-365-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty