Healthcare Provider Details

I. General information

NPI: 1457706376
Provider Name (Legal Business Name): 360 IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

IV. Provider business mailing address

3320 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

V. Phone/Fax

Practice location:
  • Phone: 501-476-3930
  • Fax: 501-503-5137
Mailing address:
  • Phone: 501-476-3930
  • Fax: 501-503-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN GOODWIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 501-219-1114