Basic Information
| Provider Information | |||||||||
| NPI: | 1235295908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUNSEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 W MARKHAM ST # 783 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | 5015265148 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 W MARKHAM ST # 532 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016865311 | ||||||||
| FaxNumber: | 5016865935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E-12598 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 200700806 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | E-125998 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | E-12598 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | NCV695A | 01 | NC | MEDICARE | OTHER | 006092969 | 05 | VA | MEDICAID | 898682 | 01 | AR | MEDICARE | OTHER | P00416083 | 01 | NC | RAIL ROAD MEDICARE | OTHER | 147F5 | 01 | NC | BCBS OF NC | OTHER | 5907167 | 05 | NC | MEDICAID | 1235295908 | 05 | NC | MEDICAID |