Healthcare Provider Details

I. General information

NPI: 1144853821
Provider Name (Legal Business Name): RESORT RADIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ADCOCK ROAD, STE B
HOT SPRINGS AR
71913-2319
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 866-601-8435
  • Fax: 479-968-1673
Mailing address:
  • Phone: 866-601-8435
  • 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: DEVON HOLDER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 501-554-5277