Provider Demographics
NPI:1316043557
Name:NATIONAL RADIOLOGY GROUP OF ARKANSAS, PLLC
Entity Type:Organization
Organization Name:NATIONAL RADIOLOGY GROUP OF ARKANSAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-299-3828
Mailing Address - Street 1:PO BOX 4738
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4738
Mailing Address - Country:US
Mailing Address - Phone:314-303-3900
Mailing Address - Fax:314-645-6548
Practice Address - Street 1:1601 NEW CASTLE RD
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-261-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C740OtherBCBSAR
ARDE6858OtherMEDICARE RR
ARDE6858OtherMEDICARE RR