Provider Demographics
NPI:1013203785
Name:SOUTHARK IMAGING LLC
Entity Type:Organization
Organization Name:SOUTHARK IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:870-310-0321
Mailing Address - Street 1:3025 N WYATT DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4189
Mailing Address - Country:US
Mailing Address - Phone:870-310-0321
Mailing Address - Fax:
Practice Address - Street 1:3025 N WYATT DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4189
Practice Address - Country:US
Practice Address - Phone:870-310-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology