Healthcare Provider Details

I. General information

NPI: 1235149469
Provider Name (Legal Business Name): POPE COUNTY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3127 W 2ND COURT STE A
RUSSELLVILLE AR
72811
US

IV. Provider business mailing address

PO BOX 9010
RUSSELLVILLE AR
72811
US

V. Phone/Fax

Practice location:
  • Phone: 479-498-6360
  • Fax: 479-498-6364
Mailing address:
  • Phone: 479-498-6360
  • Fax: 479-498-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MONTI L KIST
Title or Position: OWNER PRESIDENT
Credential:
Phone: 479-967-6492