Provider Demographics
NPI:1952318099
Name:PRIME MEDICAL IMAGING, A DIVISION OF RADIOLOGISTS, P.A.
Entity Type:Organization
Organization Name:PRIME MEDICAL IMAGING, A DIVISION OF RADIOLOGISTS, P.A.
Other - Org Name:PRIME MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:S
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-452-9416
Mailing Address - Street 1:320 SOUTH NINTH ST.
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956
Mailing Address - Country:US
Mailing Address - Phone:479-474-1616
Mailing Address - Fax:479-471-5637
Practice Address - Street 1:320 S 9TH ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5826
Practice Address - Country:US
Practice Address - Phone:479-474-1616
Practice Address - Fax:479-471-5637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGISTS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846780AMedicaid
AR146682002Medicaid