Provider Demographics
NPI:1093082877
Name:PRICE, SUSAN K (RT (R)(T))
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:PRICE
Suffix:
Gender:F
Credentials:RT (R)(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 TENNESSEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8246
Mailing Address - Country:US
Mailing Address - Phone:479-646-3282
Mailing Address - Fax:
Practice Address - Street 1:5139 TENNESSEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-8246
Practice Address - Country:US
Practice Address - Phone:479-646-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRT14992471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy