Healthcare Provider Details

I. General information

NPI: 1649320227
Provider Name (Legal Business Name): MEDICAL ASSOCIATES PA LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 S MULBERRY ST
PINE BLUFF AR
71603-7016
US

IV. Provider business mailing address

4201 S MULBERRY ST
PINE BLUFF AR
71603-7016
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-2200
  • Fax: 870-535-2208
Mailing address:
  • Phone: 870-535-2200
  • Fax: 870-535-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateAR

VIII. Authorized Official

Name: DR. JOHN D DEDMAN
Title or Position: OWNER
Credential: M.D.
Phone: 870-535-2200