Organization
RUSSELL B ALLISON
Active
Other names
Central States Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
SABRINA PARIS TENCLEVE (PRACTICE MANAGER)
(479) 890-9292
Entity
Organization
Contact information
Practice address
5395 W ASH ST STE 1, POTTSVILLE, AR 72858-9228
(479) 219-5034
Mailing address
PO BOX 1146, RUSSELLVILLE, AR 72811-1146
(479) 890-9292
(479) 890-6962
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04D2089584
CLIA
AR
Enumeration date
12/01/2015
Last updated
12/01/2015
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