Healthcare Provider Details

I. General information

NPI: 1588039291
Provider Name (Legal Business Name): LITTLE ROCK MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N FILLMORE ST
LITTLE ROCK AR
72205-3322
US

IV. Provider business mailing address

5811 W IVYBRIDGE PL
PEORIA IL
61615-9289
US

V. Phone/Fax

Practice location:
  • Phone: 314-560-9648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AHSAN USMAN
Title or Position: OWNER
Credential: MD
Phone: 314-560-9648