Organization
CHICOT RADIOLOGY CONSULTANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEERASAK TUANGSITHTANON (RADIOLOGY)
(870) 265-5074
Entity
Organization
Contact information
Practice address
2729 S HIGHWAY 65 82, LAKE VILLAGE, AR 71653-6136
(870) 265-5074
Mailing address
2729 S HIGHWAY 65 82, LAKE VILLAGE, AR 71653-6136
(870) 265-5074
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R2928
—
Other
Enumeration date
12/29/2006
Last updated
08/22/2020
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