Organization
SOUTH ARKANSAS PATHOLOGY, PLLC
Active
Parent organization
PINE BLUFF PATHOLOGISTS
Other names
Drs. Tisdale & Clark Pathologists
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE BLUFF PATHOLOGISTS
Authorized official
DR. JULIE A HARRIS M.D. (PARTNER)
(870) 541-7524
Entity
Organization
Contact information
Practice address
1600 W 40TH AVE, PINE BLUFF, AR 71603-6301
(870) 541-7524
(870) 541-7543
Mailing address
1600 W 40TH AVE, PINE BLUFF, AR 71603-6301
(870) 541-7524
(870) 541-7543
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110247002
—
AR
01
—
57283
BCBS
AR
01
—
770093502
BREASTCARE
AR
Enumeration date
05/28/2006
Last updated
10/26/2016
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