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General NPI Number Information
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NPI Number | 1942546213
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Entity Type | Organization
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Legal Business Name | MD PATHOLOGY, LLC
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 11904 KANIS RD SUITE H7
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3733
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Country | US
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Telephone | 501-687-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 CLARKSON CLAYTON CTR PO BOX 316
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City | ELLISVILLE
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State | MO
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Zip | 63011-2145
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Country | US
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Telephone | 314-803-0330
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CHRISTOPHER HARTSHORN
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Credential |
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Telephone | 314-803-0330
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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 |
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License Number State |
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