Healthcare Provider Details

I. General information

NPI: 1154240372
Provider Name (Legal Business Name): LUXE MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 E MILLSAP RD
FAYETTEVILLE AR
72703-6289
US

IV. Provider business mailing address

361 E MILLSAP RD
FAYETTEVILLE AR
72703-6289
US

V. Phone/Fax

Practice location:
  • Phone: 479-488-5893
  • Fax: 479-488-5893
Mailing address:
  • Phone: 479-488-5893
  • Fax: 479-488-5893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER LYNNE PELLHAM
Title or Position: DIRECTOR
Credential:
Phone: 479-488-5893