Organization
LAB OF PATH, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES H GOLLEHER SR. MD (MEDICAL DIRECTOR)
(501) 268-8175
Entity
Organization
Contact information
Practice address
1915 W BEEBE CAPPS EXPY, SEARCY, AR 72143-5012
(501) 268-8175
(501) 268-8337
Mailing address
1915 W BEEBE CAPPS EXPY, SEARCY, AR 72143-5012
(501) 268-8175
(501) 268-8337
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MC0253
AR
291U00000X
Clinical Medical Laboratory
MC0253
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04D0891911
CLIA NUMBER
AR
05
—
106515709
—
AR
01
—
2022102
CAP NUMBER
AR
01
—
770046609
BREASTCARE
AR
01
—
770093602
BREASTCARE OTHER
AR
01
—
MC0253
AR LICENSE
AR
Enumeration date
04/23/2007
Last updated
12/05/2013
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