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General NPI Number Information
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NPI Number | 1760660351
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Entity Type | Organization
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Legal Business Name | MED IMAGING OF ARKANSAS, PLLC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 6948 ALCOA RD SUITE G
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City | BENTON
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State | AR
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Zip | 72015-9726
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Country | US
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Telephone | 501-778-9729
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Fax | 501-776-2695
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Provider Business Mailing Address
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Address Line | 6948 ALCOA RD SUITE G
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City | BENTON
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State | AR
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Zip | 72015-9726
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Country | US
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Telephone | 501-778-9729
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Fax | 501-776-2695
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Authorized Official
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Title or Position | ADMINISTRATION MANAGER
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Name | MS. BONNIE J. ROAN
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Credential |
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Telephone | 501-778-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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