MEDICARE: RADIOLOGY SERVICES P A

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	MC0013	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154301786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY SERVICES P A

Provider Business Mailing Address
First Line	:	PO BOX 1983
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-1983
Country	:	US
Telephone Number	:	479-452-9416
Fax Number	:	479-242-1990

Provider Business Practice Location Address
First Line	:	1001 TOWSON AVE
Second Line	:
City	:	FT SMITH
State	:	AR
Zip	:	72901
Country	:	US
Telephone Number	:	918-392-2877
Fax Number	:	918-663-2281

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLINT WOOD
Credential	:	MD
Telephone Number	:	479-452-9416

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/20/2023

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