Healthcare Provider Details

I. General information

NPI: 1467492009
Provider Name (Legal Business Name): CABOT IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 WEST MAIN STREET SUITE A
CABOT AR
72023
US

IV. Provider business mailing address

500 SOUTH UNIVERSITY AVE SUITE 600
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-537-3711
  • Fax: 501-664-0302
Mailing address:
  • Phone: 501-686-2635
  • Fax: 501-664-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberMC-0023
License Number StateAR

VIII. Authorized Official

Name: TAUNIA STADTER
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 501-686-2635