NPIMap

Organization Active NPI

South Arkansas Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Pine Bluff, AR
National Provider Identifier
1376590083
Registry record updated Oct 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 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
Last updated
Oct 26, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PINE BLUFF PATHOLOGISTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

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 names 1

  • Drs. Tisdale & Clark Pathologists Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

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

National Provider Directory
Part of
Pine Bluff Pathologists PLLC

Ownership & related parties

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 & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Tisdale & Clark Pathologists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.