Provider Demographics
NPI:1326083973
Name:BAPTIST HEALTH IMAGING CENTER - HIGHWAY 10 LLC
Entity Type:Organization
Organization Name:BAPTIST HEALTH IMAGING CENTER - HIGHWAY 10 LLC
Other - Org Name:BAPTIST HEALTH IMAGING CENTER - WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2274
Mailing Address - Street 1:9601 INTERSTATE 630 EXIT 7
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7202
Mailing Address - Country:US
Mailing Address - Phone:501-202-2274
Mailing Address - Fax:501-202-1722
Practice Address - Street 1:4200 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2461
Practice Address - Country:US
Practice Address - Phone:501-202-2274
Practice Address - Fax:501-202-1722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3886261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C781Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER