MEDICARE: LUXE MEDICAL IMAGING, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1831071711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXE MEDICAL IMAGING, LLC

Provider Business Mailing Address
First Line	:	361 E MILLSAP RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-6289
Country	:	US
Telephone Number	:	479-488-5893
Fax Number	:	479-488-5893

Provider Business Practice Location Address
First Line	:	361 E MILLSAP RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-6289
Country	:	US
Telephone Number	:	479-595-0000
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AMBER PELLHAM
Credential	:
Telephone Number	:	479-488-5893

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	03/25/2026

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