Provider Demographics
NPI:1265544373
Name:DIAGNOSTIC PHYSICIANS OF ARKANSAS, PA
Entity type:Organization
Organization Name:DIAGNOSTIC PHYSICIANS OF ARKANSAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-955-1156
Mailing Address - Street 1:4509 E MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2902
Mailing Address - Country:US
Mailing Address - Phone:501-945-8080
Mailing Address - Fax:501-945-5040
Practice Address - Street 1:4509 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2902
Practice Address - Country:US
Practice Address - Phone:501-945-8080
Practice Address - Fax:501-945-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC2053207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCF9997OtherRAIL ROAD MEDICARE
AR5C147OtherBLUE CROSS BLUE SHIELD
AR5C147Medicare ID - Type Unspecified