| Organization Name: | INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY OF SOUTH ARKANSAS, P.A. |
| NPI Number: | 1548599988 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENDA WILSON (BUSINESS MANAGER) |
| Mailing Address: | 700 W Grove St El Dorado |
| State: | AR US |
| Postal Code: | 717304416 |
| Phone Number: | 8708621577 |
| Fax Number: | 8708625916 |
| NPI Enumeration Date: | 12/14/2009 |
| NPI Last Update Date: | 12/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | C5187 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |