Healthcare Provider Details

I. General information

NPI: 1003806258
Provider Name (Legal Business Name): HOT SPRINGS RADIOLOGY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 CENTRAL AVE STE D
HOT SPRINGS AR
71913-6404
US

IV. Provider business mailing address

3633 CENTRAL AVE STE D
HOT SPRINGS AR
71913-6404
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-6693
  • Fax: 501-623-6693
Mailing address:
  • Phone: 501-623-6693
  • Fax: 501-623-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMC-0131
License Number StateAR

VIII. Authorized Official

Name: STEPHEN PATRICK PENOR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-623-6693