Provider Demographics
NPI:1992917728
Name:RADIOLOGY CONSULTANTS OF NORTHWEST ARKANSAS
Entity type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF NORTHWEST ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-968-8279
Mailing Address - Street 1:P.O. BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801
Mailing Address - Country:US
Mailing Address - Phone:479-968-8279
Mailing Address - Fax:479-968-4331
Practice Address - Street 1:3205 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2301
Practice Address - Country:US
Practice Address - Phone:479-968-8279
Practice Address - Fax:479-968-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
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
AR57672OtherBCBS OR ARKANSAS
AR57672Medicare ID - Type UnspecifiedMEDICARE