1992917728 NPI number — RADIOLOGY CONSULTANTS OF NORTHWEST ARKANSAS

Table of content: (NPI 1992917728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992917728 NPI number — RADIOLOGY CONSULTANTS OF NORTHWEST ARKANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY CONSULTANTS OF NORTHWEST ARKANSAS
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:
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:
1992917728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 9178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-968-8279
Provider Business Mailing Address Fax Number:
479-968-4331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-968-8279
Provider Business Practice Location Address Fax Number:
479-968-4331
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COUCH
Authorized Official First Name:
KERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
479-968-8279

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 57672 . This is a "BCBS OR ARKANSAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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