NPIMap

South Arkansas Pathology, PLLC

Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Pine Bluff, AR

NPI 1376590083 · NPPES record last updated Oct 26, 2016

Key facts

NPI
1376590083
Entity type
Organization (NPI type 2)
Primary specialty
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
Legal business name
SOUTH ARKANSAS PATHOLOGY, PLLC
Practice address
1600 W 40TH Ave
Pine Bluff, AR 71603-6301
Phone
(870) 541-7524
Fax
(870) 541-7543
NPI assigned
May 28, 2006
Organization subpart
Yes
Parent organization (as reported)
PINE BLUFF PATHOLOGISTS

Authorized official

Name
Dr. Julie A Harris, M.D. NPI 1760676860
Title
Partner
Phone
(870) 541-7524

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20171016003009 AR Part B Supplier - Clinic/Group Practice 2567738701 Receives reassigned benefits from 3 practitioners
Practice locations: Pine Bluff, AR

National Provider Directory

Part of
Pine Bluff Pathologists PLLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207ZP0102X Yes

Addresses

Primary practice location

1600 W 40TH Ave
Pine Bluff, AR 71603-6301

Mailing address

1600 W 40TH Ave
Pine Bluff, AR 71603-6301
Phone (870) 541-7524

Other identifiers

IdentifierTypeStateIssuer
770093502OtherARBREASTCARE
57283OtherARBCBS
110247002MedicaidAR

Other names

  • Drs. Tisdale & Clark Pathologists Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 26, 2016.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1376590083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7524",
            "fax_number": "870-541-7543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7524",
            "fax_number": "870-541-7543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ARKANSAS PATHOLOGY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINE BLUFF PATHOLOGISTS",
        "enumeration_date": "2006-05-28",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "870-541-7524",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREASTCARE",
            "identifier": "770093502",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "57283",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110247002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Tisdale & Clark Pathologists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pine Bluff, AR

All providers in Pine Bluff, AR · Anatomic Pathology & Clinical Pathology Physician in Arkansas

Sources for this page

Verify at the official NPI Registry.