Stateline Medical Ar LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

STATELINE MEDICAL AR LLC

Practice address

12204 W Highway 62
Farmington, AR 72730-9560

Phone

(479) 561-2448

NPI assigned

Jul 24, 2018

Organization subpart

No

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

Authorized official

Name

Brittany Fox

Title

Co-Owner

Phone

(479) 650-9459

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532390400000",
    "number": "1568949436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BELHAVEN VIEW CT",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729089063",
            "telephone_number": "479-650-9459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12204 W HIGHWAY 62",
            "city": "FARMINGTON",
            "state": "AR",
            "postal_code": "727309560",
            "telephone_number": "479-561-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELINE MEDICAL AR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "479-650-9459"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Farmington, AR
• Providers in Farmington, AR by specialty
• Clinical Medical Laboratory in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.