Provider Demographics
NPI:1972568475
Name:PROFESSIONAL RADIOLOGY SERVICES, PA
Entity Type:Organization
Organization Name:PROFESSIONAL RADIOLOGY SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HEDGECOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-631-9766
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-1688
Mailing Address - Country:US
Mailing Address - Phone:479-631-9766
Mailing Address - Fax:479-631-9492
Practice Address - Street 1:302 N 8TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3738
Practice Address - Country:US
Practice Address - Phone:479-631-9766
Practice Address - Fax:479-631-9492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B452Medicare ID - Type Unspecified