Provider Demographics
NPI:1891786935
Name:PROSCAN IMAGING OF ARKANSAS, LLC
Entity Type:Organization
Organization Name:PROSCAN IMAGING OF ARKANSAS, LLC
Other - Org Name:PROSCAN IMAGING ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:M D
Authorized Official - Phone:501-227-7688
Mailing Address - Street 1:9101 KANIS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6417
Mailing Address - Country:US
Mailing Address - Phone:501-227-7688
Mailing Address - Fax:501-228-3509
Practice Address - Street 1:9101 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6417
Practice Address - Country:US
Practice Address - Phone:501-224-7226
Practice Address - Fax:501-225-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00233253OtherRAILROAD MEDICARE
AR5F201Medicare PIN