| Organization Name: | SAMA INDEPENDENT DIAGNOSTIC TESTING FACILITY |
| NPI Number: | 1053307108 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY E DETWILER (ADMINISTRATOR) |
| Mailing Address: | 600 S Timberlane Dr El Dorado |
| State: | AR US |
| Postal Code: | 717306990 |
| Phone Number: | 8708622400 |
| Fax Number: | 8708621891 |
| NPI Enumeration Date: | 09/23/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | 223250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |