Healthcare Provider Details

I. General information

NPI: 1932255486
Provider Name (Legal Business Name): NEA CLINIC IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 APACHE DR STE C1
JONESBORO AR
72401-7426
US

IV. Provider business mailing address

3100 APACHE DR STE C1
JONESBORO AR
72401-7426
US

V. Phone/Fax

Practice location:
  • Phone: 870-934-3533
  • Fax:
Mailing address:
  • Phone: 870-934-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOT DAVIS
Title or Position: COO
Credential:
Phone: 870-934-5108