MEDICARE: PROSCAN RADIOLOGY ARKANSAS, LLC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1124471149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSCAN RADIOLOGY ARKANSAS, LLC

Provider Business Mailing Address
First Line	:	2929 LAKEWOOD VILLAGE DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 LAKEWOOD VILLAGE DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8033
Country	:	US
Telephone Number	:	513-924-2115
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, CORPORATE ADMIN.
Name	:	KAREN E AMAYA
Credential	:
Telephone Number	:	513-924-5174

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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