Provider Demographics
NPI:1316139231
Name:WEST MEMPHIS PET IMAGING, LLC
Entity type:Organization
Organization Name:WEST MEMPHIS PET IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:RONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-732-8200
Mailing Address - Street 1:316 W TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4225
Mailing Address - Country:US
Mailing Address - Phone:870-732-8200
Mailing Address - Fax:870-732-8201
Practice Address - Street 1:316 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4225
Practice Address - Country:US
Practice Address - Phone:870-732-8200
Practice Address - Fax:870-732-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F852Medicare PIN