Organization
PATHOLOGY LABS OF AR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH E MILLER (ADMINISTRATOR)
(501) 225-7711
Entity
Organization
Contact information
Practice address
1 LILE CT, SUITE 101, LITTLE ROCK, AR 72205-6242
(501) 225-7711
(501) 225-7108
Mailing address
1 LILE CT, SUITE 101, LITTLE ROCK, AR 72205-6242
(501) 225-7711
(501) 225-7108
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104544002
—
AR
01
—
18132
MEDICARE PTAN
AR
Enumeration date
12/04/2008
Last updated
12/04/2008
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