Healthcare Provider Details

I. General information

NPI: 1215931290
Provider Name (Legal Business Name): ASSOCIATED RADIOLOGISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

IV. Provider business mailing address

800 S CHURCH ST STE 101
JONESBORO AR
72401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-6654
  • Fax: 870-932-0526
Mailing address:
  • Phone: 870-910-6654
  • Fax: 870-932-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMC0222
License Number StateAR

VIII. Authorized Official

Name: KIM LOPERANO
Title or Position: ADMINISTRATION
Credential:
Phone: 870-910-6654