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General NPI Number Information
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NPI Number | 1154662880
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Entity Type | Organization
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Legal Business Name | SIGMA MOLECULAR DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 5100 TALLEY RD STE 300
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8040
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Country | US
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Telephone | 501-850-0202
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Fax | 501-850-0211
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Provider Business Mailing Address
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Address Line | 5100 TALLEY RD STE 300
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8040
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Country | US
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Telephone | 501-850-0202
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Fax | 501-850-0211
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Authorized Official
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Title or Position | OWNER
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Name | MR. JIMMY DON THREET
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Credential |
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Telephone | 501-850-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | BL149153
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License Number State | AR
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