Provider Demographics
NPI:1639651599
Name:RADIOLOGY PROFESSIONAL MANAGEMENT INC
Entity Type:Organization
Organization Name:RADIOLOGY PROFESSIONAL MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-208-0622
Mailing Address - Street 1:102 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-2349
Mailing Address - Country:US
Mailing Address - Phone:479-208-0622
Mailing Address - Fax:479-667-4442
Practice Address - Street 1:102 N 17TH ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-2349
Practice Address - Country:US
Practice Address - Phone:479-208-0622
Practice Address - Fax:479-667-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty