Organization
ELL PATHOLOGY LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK D WALKER M.D. (OWNER & DIRECTOR)
(501) 604-2695
Entity
Organization
Contact information
Practice address
10810 EXECUTIVE CENTER DR STE 100, LITTLE ROCK, AR 72211-4386
(501) 604-2695
(501) 604-2699
Mailing address
10810 EXECUTIVE CENTER DR STE 101, LITTLE ROCK, AR 72211-4386
(501) 604-2695
(501) 604-2699
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04D2068199
CLIA
AR
01
—
LAP80759
NYSDOH CLINICAL LABORATORY PERMIT
AR
Enumeration date
09/18/2014
Last updated
05/22/2015
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