Provider Demographics
NPI:1922178060
Name:DOCTORS TESTING CENTER LLC II
Entity Type:Organization
Organization Name:DOCTORS TESTING CENTER LLC II
Other - Org Name:DOCTORS HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-985-9944
Mailing Address - Street 1:2227 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-985-9944
Mailing Address - Fax:501-985-6590
Practice Address - Street 1:2227 W MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4207
Practice Address - Country:US
Practice Address - Phone:501-985-9944
Practice Address - Fax:501-985-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C724OtherIDTF
AR5C652OtherMEDICARE