Provider Demographics
NPI:1144212341
Name:PINE BLUFF RADIOLOGISTS, LTD
Entity Type:Organization
Organization Name:PINE BLUFF RADIOLOGISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-534-8651
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6900
Mailing Address - Country:US
Mailing Address - Phone:870-534-8651
Mailing Address - Fax:870-534-2827
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6900
Practice Address - Country:US
Practice Address - Phone:870-534-8651
Practice Address - Fax:870-534-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-0028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty