Provider Demographics
NPI:1467492009
Name:CABOT IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:CABOT IMAGING CENTER, LLC
Other - Org Name:CABOT IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAUNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STADTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-686-2635
Mailing Address - Street 1:500 SOUTH UNIVERSITY AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-686-2635
Mailing Address - Fax:501-664-0302
Practice Address - Street 1:2039 WEST MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-537-3711
Practice Address - Fax:501-664-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-0023261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology