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General NPI Number Information
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NPI Number | 1376947804
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Entity Type | Organization
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Legal Business Name | BLOOD AND CANCER INSTITUTE OF LITTLE ROCK
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE SUITE 808
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-664-1274
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Fax | 501-664-4236
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE SUITE 808
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-664-1274
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Fax | 501-664-4236
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Authorized Official
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Title or Position | OWNER
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Name | ASIF MASOOD
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Credential | M.D.
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Telephone | 501-664-1274
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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 | 1760448013
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License Number State | AR
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