Provider Demographics
NPI:1033399282
Name:NEA X-RAY INC
Entity Type:Organization
Organization Name:NEA X-RAY INC
Other - Org Name:MEDSOUTH MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:YOUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-0330
Mailing Address - Street 1:7665 COUNTS MASSIE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6656
Mailing Address - Country:US
Mailing Address - Phone:501-224-0330
Mailing Address - Fax:501-224-0356
Practice Address - Street 1:7665 COUNTS MASSIE RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6656
Practice Address - Country:US
Practice Address - Phone:501-224-0330
Practice Address - Fax:501-224-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR48390OtherBLUE CROSS BLUE SHIELD
AR176146716Medicaid
AR48390OtherBLUE CROSS BLUE SHIELD