Healthcare Provider Details

I. General information

NPI: 1316139231
Provider Name (Legal Business Name): WEST MEMPHIS PET IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W TYLER AVE
WEST MEMPHIS AR
72301-4225
US

IV. Provider business mailing address

316 W TYLER AVE
WEST MEMPHIS AR
72301-4225
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-8200
  • Fax: 870-732-8201
Mailing address:
  • Phone: 870-732-8200
  • Fax: 870-732-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD STEVEN RONEY
Title or Position: CHIEF MANAGER
Credential: MD
Phone: 870-732-8200