Provider Demographics
NPI:1861857658
Name:HOT SPRINGS IMAGING CENTER LLC
Entity Type:Organization
Organization Name:HOT SPRINGS IMAGING CENTER LLC
Other - Org Name:HOT SPRINGS IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9800
Mailing Address - Street 1:120 ADCOCK RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7958
Mailing Address - Country:US
Mailing Address - Phone:501-767-1538
Mailing Address - Fax:
Practice Address - Street 1:120 ADCOCK RD.
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7958
Practice Address - Country:US
Practice Address - Phone:501-767-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
293D00000X
ARPP02145293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216605710Medicaid
AR216605710Medicaid