Provider Demographics
NPI:1407836893
Name:MISTY MOUNTAIN IMAGING, INC.
Entity Type:Organization
Organization Name:MISTY MOUNTAIN IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-491-5555
Mailing Address - Street 1:530 COUNTY ROAD 675
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-9834
Mailing Address - Country:US
Mailing Address - Phone:870-491-5555
Mailing Address - Fax:870-491-7638
Practice Address - Street 1:530 COUNTY ROAD 675
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-9834
Practice Address - Country:US
Practice Address - Phone:870-491-5555
Practice Address - Fax:870-491-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QR0208X261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile