1952318099 NPI number — PRIME MEDICAL IMAGING, A DIVISION OF RADIOLOGISTS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952318099 NPI number — PRIME MEDICAL IMAGING, A DIVISION OF RADIOLOGISTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME MEDICAL IMAGING, A DIVISION OF RADIOLOGISTS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIME MEDICAL IMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952318099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 SOUTH NINTH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN BUREN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-474-1616
Provider Business Mailing Address Fax Number:
479-471-5637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN BUREN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72956-5826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-474-1616
Provider Business Practice Location Address Fax Number:
479-471-5637
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
479-452-9416

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100846780A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146682002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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