Healthcare Provider Details

I. General information

NPI: 1033399282
Provider Name (Legal Business Name): NEA X-RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 COUNTS MASSIE RD
NORTH LITTLE ROCK AR
72113-6656
US

IV. Provider business mailing address

7665 COUNTS MASSIE RD
NORTH LITTLE ROCK AR
72113-6656
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-0330
  • Fax: 501-224-0356
Mailing address:
  • Phone: 501-224-0330
  • Fax: 501-224-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. SCOTT DEAN YOUNGE
Title or Position: OWNER
Credential:
Phone: 501-224-0330