Basic Information
| Provider Information | |||||||||
| NPI: | 1326083973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST HEALTH IMAGING CENTER - HIGHWAY 10 LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAPTIST HEALTH IMAGING CENTER - WEST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9601 INTERSTATE 630 EXIT 7 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012022274 | ||||||||
| FaxNumber: | 5012021722 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 N RODNEY PARHAM RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722122461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012022274 | ||||||||
| FaxNumber: | 5012021722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 03/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5012022274 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | AR3886 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.