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General NPI Number Information
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NPI Number | 1346356573
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Entity Type | Organization
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Legal Business Name | MEDICAL INVESTMENTS OF TEXARKANA LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 4303 TEXAS BLVD STE 8
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City | TEXARKANA
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State | TX
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Zip | 75503-3094
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Country | US
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Telephone | 479-968-7930
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Fax | 479-968-1673
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 479-968-7930
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Fax | 479-968-1673
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Authorized Official
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Title or Position | ACCOUNTS MANAGER
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Name | RODNEY THOMASON
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Credential |
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Telephone | 479-968-7930
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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 |
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License Number State |
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