Healthcare Provider Details

I. General information

NPI: 1053686964
Provider Name (Legal Business Name): ADVANCED PATHOLOGY SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5328 NORTHSHORE CV
NORTH LITTLE ROCK AR
72118-5332
US

IV. Provider business mailing address

5328 NORTHSHORE CV
NORTH LITTLE ROCK AR
72118-5332
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-1400
  • Fax: 501-225-1401
Mailing address:
  • Phone: 501-225-1400
  • Fax: 501-225-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. BRANDON CRAIN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 501-225-1400