Organization
DELTA DIAGNOSTIC & THERAPEUTIC RAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA M SIMPSON (PRESIDENT)
(870) 850-6053
Entity
Organization
Contact information
Practice address
316 W 6TH AVE, PINE BLUFF, AR 71601-4217
(870) 850-6053
(870) 850-6482
Mailing address
316 W 6TH AVE, PINE BLUFF, AR 71601-4217
(870) 850-6053
(870) 850-6482
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R2333
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155956002
—
AR
01
—
5C647
AR BLUE CROSS BLUE SHIELD
AR
01
—
770218402
BREAST CARE
AR
01
—
DC3930
PALMETTO GBA GROUP
AR
Enumeration date
06/20/2006
Last updated
05/13/2010
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