Provider Demographics
NPI:1902849276
Name:ARKANSAS DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:ARKANSAS DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-7688
Mailing Address - Street 1:8908 KANIS RD
Mailing Address - Street 2:P.O. BOX 55130
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6414
Mailing Address - Country:US
Mailing Address - Phone:501-227-7688
Mailing Address - Fax:501-225-2930
Practice Address - Street 1:8907 KANIS RD
Practice Address - Street 2:SUITE 403
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6449
Practice Address - Country:US
Practice Address - Phone:501-217-9382
Practice Address - Fax:501-225-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100013053OtherRAILROAD DR ZILLER
AR117730002Medicaid
ARCC6622OtherRAILORAD MEDICARE
AR010009296OtherRAILROAD DR WMS
AR117730002Medicaid