Provider Demographics
NPI:1871575894
Name:MRI CENTRAL LITTLE ROCK INC
Entity type:Organization
Organization Name:MRI CENTRAL LITTLE ROCK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:F
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-368-9966
Mailing Address - Street 1:12225 GREENVILLE AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9338
Mailing Address - Country:US
Mailing Address - Phone:877-361-8018
Mailing Address - Fax:888-542-6858
Practice Address - Street 1:4020 RICHARDS RD STE D
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2744
Practice Address - Country:US
Practice Address - Phone:501-945-9990
Practice Address - Fax:501-945-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160627002Medicaid
AR5F386Medicare PIN
ARY54311Medicare UPIN
P00297620Medicare PIN