Healthcare Provider Details

I. General information

NPI: 1154364271
Provider Name (Legal Business Name): ORTHOARKANSAS SPECIAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 KANIS RD
LITTLE ROCK AR
72205-6205
US

IV. Provider business mailing address

10301 KANIS RD
LITTLE ROCK AR
72205-6205
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-4192
  • Fax: 501-604-4159
Mailing address:
  • Phone: 501-604-4192
  • Fax: 501-604-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KASONDRA RODGERS
Title or Position: DIRECTOR, SPECIAL IMAGING
Credential:
Phone: 501-604-4192