1326083973 NPI number — BAPTIST HEALTH IMAGING CENTER - HIGHWAY 10 LLC

Table of content: (NPI 1326083973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326083973 NPI number — BAPTIST HEALTH IMAGING CENTER - HIGHWAY 10 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST HEALTH IMAGING CENTER - HIGHWAY 10 LLC
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:
Provider Other Organization Name Type Code:
6
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:
1326083973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 INTERSTATE 630 EXIT 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-7202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-202-2274
Provider Business Mailing Address Fax Number:
501-202-1722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 N RODNEY PARHAM RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72212-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-202-2274
Provider Business Practice Location Address Fax Number:
501-202-1722
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
501-202-2274

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  AR3886 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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