Healthcare Provider Details

I. General information

NPI: 1316327943
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF THE OZARKS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST
HARRISON AR
72601-2911
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 800-962-0093
  • Fax:
Mailing address:
  • Phone: 800-962-0093
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON HICKS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 800-962-0093