Basic Information
| Provider Information | |||||||||
| NPI: | 1467492009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CABOT IMAGING CENTER, LLC | ||||||||
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| OtherOrganizationName: | CABOT IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 SOUTH UNIVERSITY AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016862635 | ||||||||
| FaxNumber: | 5016640302 | ||||||||
| Practice Location | |||||||||
| Address1: | 2039 WEST MAIN STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CABOT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015373711 | ||||||||
| FaxNumber: | 5016640302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STADTER | ||||||||
| AuthorizedOfficialFirstName: | TAUNIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5016862635 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | MC-0023 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.