Provider Demographics
NPI:1528079316
Name:SILVER BULLET SCANNING SERVICE LLC
Entity type:Organization
Organization Name:SILVER BULLET SCANNING SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS/RVT/RDCS
Authorized Official - Phone:870-715-2802
Mailing Address - Street 1:1501 W STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3915
Mailing Address - Country:US
Mailing Address - Phone:870-715-2802
Mailing Address - Fax:870-741-6853
Practice Address - Street 1:1501 W STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3915
Practice Address - Country:US
Practice Address - Phone:870-715-2802
Practice Address - Fax:870-741-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10541246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148708741OtherAR. MEDICAID CROSSOVER #
AR148708741OtherAR. MEDICAID CROSSOVER #
AR5C691Medicare ID - Type UnspecifiedAR. MEDICARE PROVIDER #