Provider Demographics
NPI:1952471849
Name:RADIOLOGY ASSOCIATES OF EL DORADO PLLC
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF EL DORADO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-862-1577
Mailing Address - Street 1:611 THOMPSON AVE
Mailing Address - Street 2:P.O. BOX 506
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4557
Mailing Address - Country:US
Mailing Address - Phone:870-862-1577
Mailing Address - Fax:870-862-5916
Practice Address - Street 1:700 W GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4416
Practice Address - Country:US
Practice Address - Phone:870-862-1577
Practice Address - Fax:870-862-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134938002Medicaid
AR=========OtherFED TAX ID NUMBER GROUP
AR=========OtherFED TAX ID NUMBER GROUP