Provider Demographics
NPI:1235149469
Name:POPE COUNTY IMAGING
Entity Type:Organization
Organization Name:POPE COUNTY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-967-6492
Mailing Address - Street 1:PO BOX 9010
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-498-6360
Mailing Address - Fax:479-498-6364
Practice Address - Street 1:3127 W 2ND COURT
Practice Address - Street 2:STE A
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72811
Practice Address - Country:US
Practice Address - Phone:479-498-6360
Practice Address - Fax:479-498-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLIMITED LIABILITY261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F254Medicare PIN