1053686964 NPI number — ADVANCED PATHOLOGY SOLUTIONS, PLLC

Table of content: (NPI 1053686964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053686964 NPI number — ADVANCED PATHOLOGY SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PATHOLOGY SOLUTIONS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053686964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5328 NORTHSHORE CV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72118-5332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-225-1400
Provider Business Mailing Address Fax Number:
501-225-1401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5328 NORTHSHORE CV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72118-5332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-225-1400
Provider Business Practice Location Address Fax Number:
501-225-1401
Provider Enumeration Date:
03/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CRAIN
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
501-225-1400

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4554062 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100437940 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q028327 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053686964 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3564890 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053686964 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200633580A , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33124566 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184345 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198170709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 905992 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04554062 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002650900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201390500A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700037530 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107560700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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