Healthcare Provider Details

I. General information

NPI: 1952318099
Provider Name (Legal Business Name): PRIME MEDICAL IMAGING, A DIVISION OF RADIOLOGISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S 9TH ST
VAN BUREN AR
72956-5826
US

IV. Provider business mailing address

320 SOUTH NINTH ST.
VAN BUREN AR
72956
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-1616
  • Fax: 479-471-5637
Mailing address:
  • Phone: 479-474-1616
  • Fax: 479-471-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGG S DANIELS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 479-452-9416