MEDICARE: NEA X-RAY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier		AR
2	332B00000X	Durable Medical Equipment & Medical Supplies		AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48390	OTHER	AR	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033399282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEA X-RAY INC

Provider Business Mailing Address
First Line	:	7665 COUNTS MASSIE RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-6656
Country	:	US
Telephone Number	:	501-224-0330
Fax Number	:	501-224-0356

Provider Business Practice Location Address
First Line	:	7665 COUNTS MASSIE RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-6656
Country	:	US
Telephone Number	:	501-224-0330
Fax Number	:	501-224-0356

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT DEAN YOUNGE
Credential	:
Telephone Number	:	501-224-0330

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	08/25/2009

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