Healthcare Provider Details

I. General information

NPI: 1275606253
Provider Name (Legal Business Name): SSMRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WILLOW CREEK DR SUITE 200
SPRINGDALE AR
72762-8704
US

IV. Provider business mailing address

108 CROSSOVER AVE SUITE E
LOWELL AR
72745-8937
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-4553
  • Fax: 479-251-1006
Mailing address:
  • Phone: 479-770-6333
  • Fax: 479-770-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC4750
License Number StateAR

VIII. Authorized Official

Name: DR. DAN M RINER
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 479-770-6333