Organization
ST.BERNARDS PET CENTER LLC
Active
Organization
ST.BERNARDS PET CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY THOMASON (MANAGER)
(479) 968-7930
Entity
Organization
Contact information
Practice address
225 E JACKSON AVE, JONESBORO, AR 72401-3119
(877) 223-3988
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-7930
(479) 968-1673
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146893002
—
AR
01
—
5C658
BCBS PROVIDER NUMBER
AR
Enumeration date
04/07/2006
Last updated
12/17/2013
Update your record
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