Provider Demographics
NPI:1760660351
Name:MED IMAGING OF ARKANSAS, PLLC
Entity type:Organization
Organization Name:MED IMAGING OF ARKANSAS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-778-9729
Mailing Address - Street 1:6948 ALCOA RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-9726
Mailing Address - Country:US
Mailing Address - Phone:501-778-9729
Mailing Address - Fax:501-776-2695
Practice Address - Street 1:6948 ALCOA RD
Practice Address - Street 2:SUITE G
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-9726
Practice Address - Country:US
Practice Address - Phone:501-778-9729
Practice Address - Fax:501-776-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00685566OtherRAILROAD MEDICARE
AR1760660351OtherWINDSOR
AR171546002Medicaid
AR2919223OtherUHC
AR4444567OtherCIGNA
AR4444567OtherCIGNA
AR2919223OtherUHC