Healthcare Provider Details

I. General information

NPI: 1154301786
Provider Name (Legal Business Name): RADIOLOGY SERVICES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FT SMITH AR
72901
US

IV. Provider business mailing address

PO BOX 1983
FORT SMITH AR
72902-1983
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-2877
  • Fax: 918-663-2281
Mailing address:
  • Phone: 479-452-9416
  • Fax: 479-242-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMC0013
License Number StateAR

VIII. Authorized Official

Name: CLINT WOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 479-452-9416