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Ambulatory Health Care Facilities Clinic/Center Radiology, Mammography

Provider NPI: 1245456789

Organization Information:
Organization is not Subpart
Authorized Official:  LISA R MELTON  CLINIC DIRECTOR  870-262-6039

Practice Location:
Tel: 870-257-6060  Fax: --

Business Mailing Address:
Tel: 870-257-6060  Fax: 870-257-7667

NPI Information:
NPI: 1245456789
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y261QR0206XAmbulatory Health Care Facilities
Radiology, Mammography

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 261QR0206X





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