MEDICARE: MISS MISHA MAHMOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1104607381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MISHA MAHMOOD

Provider Business Mailing Address
First Line	:	3024 E WOODSON LATERAL RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9169
Country	:	US
Telephone Number	:	870-534-2900
Fax Number	:	870-534-9726

Provider Business Practice Location Address
First Line	:	3024 E WOODSON LATERAL RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9169
Country	:	US
Telephone Number	:	870-534-2900
Fax Number	:	870-534-9726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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Directions to “ MISS MISHA MAHMOOD ” Practice Location

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