Organization
FAYETTEVILLE MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRI COUCH (MANAGER)
(479) 968-7930
Entity
Organization
Contact information
Practice address
3873 N PARKVIEW DR, NO.6, FAYETTEVILLE, AR 72703-6286
(800) 654-0378
(479) 968-4331
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-7930
(479) 968-4331
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149120002
—
AR
01
—
5C735
BCBS PROVIDER NUMBER
AR
Enumeration date
04/07/2006
Last updated
02/13/2009
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