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General NPI Number Information
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NPI Number | 1265651459
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Entity Type | Organization
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Legal Business Name | OUTPATIENT RADIOLOGY CLINIC PA
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 SOUTH ROHDES STE B
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City | WEST MEMPHIS
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State | AR
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Zip | 72301
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Country | US
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Telephone | 870-735-5555
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Fax | 870-735-5660
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Provider Business Mailing Address
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Address Line | 200 SOUTH ROHDES STE B
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City | WEST MEMPHIS
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State | AR
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Zip | 72301
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Country | US
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Telephone | 870-735-5555
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Fax | 870-735-5660
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Authorized Official
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Title or Position | PHYSICIAN RADIOLOGIST
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Name | DR. EDGAR SCOTT FERGUSON SR.
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Credential | MD
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Telephone | 870-735-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD14662
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C6304
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License Number State | AR
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