Provider Demographics
NPI:1568506715
Name:ARKANSAS MRI SERVICES LLC
Entity Type:Organization
Organization Name:ARKANSAS MRI SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:479-254-0434
Mailing Address - Street 1:1703 PHYLLIS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7094
Mailing Address - Country:US
Mailing Address - Phone:479-254-0434
Mailing Address - Fax:479-254-0032
Practice Address - Street 1:1703 PHYLLIS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7094
Practice Address - Country:US
Practice Address - Phone:479-254-0434
Practice Address - Fax:479-254-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0030511261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F393Medicare ID - Type UnspecifiedMEDICARE IDTF