Provider Demographics
NPI:1154364271
Name:ORTHOARKANSAS SPECIAL IMAGING
Entity type:Organization
Organization Name:ORTHOARKANSAS SPECIAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SPECIAL IMAGING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-604-4192
Mailing Address - Street 1:10301 KANIS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6205
Mailing Address - Country:US
Mailing Address - Phone:501-604-4192
Mailing Address - Fax:501-604-4159
Practice Address - Street 1:10301 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6205
Practice Address - Country:US
Practice Address - Phone:501-604-4192
Practice Address - Fax:501-604-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C322Medicare ID - Type Unspecified
0465700001Medicare NSC
AR0465700001Medicare NSC