MEDICARE: RADIOLOGY ASSOCIATES OF NORTH ARKANSAS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57420	OTHER	AR	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891758405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES OF NORTH ARKANSAS

Provider Business Mailing Address
First Line	:	PO BOX 9178
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811-9178
Country	:	US
Telephone Number	:	479-968-7930
Fax Number	:	479-968-1673

Provider Business Practice Location Address
First Line	:	620 N MAIN ST
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-2911
Country	:	US
Telephone Number	:	877-561-3023
Fax Number	:	479-968-1673

Authorized Official
Title or Position	:	PHYSICAN/OWNER
Name	:	CHRISTOPHER BENNETT
Credential	:
Telephone Number	:	479-968-7930

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	01/02/2014

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