Basic Information
| Provider Information | |||||||||
| NPI: | 1164894259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LDC CARDIAC REHAB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94 | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717540094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702343488 | ||||||||
| FaxNumber: | 8702343488 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 S HAZEL ST | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716037836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705352800 | ||||||||
| FaxNumber: | 8705352801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | FALLIN | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | LEANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8709045848 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BSE, RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.