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NPI Code Detail

MEDICARE: NATURAL STATE GENOMICS LLC

MEDICARE: NATURAL STATE GENOMICS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1861032633
Entity Type Code : Organization
Provider Name (Legal Business Name) : NATURAL STATE GENOMICS LLC
Provider Business Mailing Address
First Line : PO BOX 26110
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72221-6110
Country : US
Telephone Number : 501-350-6597
Fax Number :
Provider Business Practice Location Address
First Line : 10915 N RODNEY PARHAM RD STE C
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72212-4202
Country : US
Telephone Number : 501-539-1094
Fax Number : 800-948-3816
Authorized Official
Title or Position : PRESIDENT
Name : CASEY HONEYCUTT
Credential :
Telephone Number : 501-350-6597
Provider Enumeration Date : 01/09/2020
Last Update Date : 06/18/2024

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Directions to “NATURAL STATE GENOMICS LLC ” Practice Location

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