=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023355385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STONEBRIAR IMAGING OF NORTH LITTLE ROCK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2013
-----------------------------------------------------
Last Update Date | 01/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3320 SPRINGHILL DR SUITE 100
-----------------------------------------------------
City | N LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72117-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-461-4852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3320 SPRINGHILL DR SUITE 100
-----------------------------------------------------
City | N LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72116-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MR. PHILLIP A. CLIFFORD JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-793-7309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------