MEDICARE: NORTHWEST ARKANSAS MEDICAL IMAGING, 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1083694012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST ARKANSAS MEDICAL IMAGING, INC

Provider Business Mailing Address
First Line	:	361 E MILLSAP RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-6289
Country	:	US
Telephone Number	:	479-587-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 E MILLSAP RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-6289
Country	:	US
Telephone Number	:	479-587-3000
Fax Number	:	479-587-3005

Authorized Official
Title or Position	:	ADMINISRATOR
Name	:	PAMELA MATHIASEN
Credential	:
Telephone Number	:	479-587-3000

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	08/22/2020

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