Lab of Path, PA

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

MC0253 Issued in AR

Legal business name

LAB OF PATH, PA

Practice address

1915 W Beebe Capps Expy
Searcy, AR 72143-5012

Phone

(501) 268-8175

Fax

(501) 268-8337

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. James H Golleher Sr., MDNPI 1356319438

Title

Medical Director

Phone

(501) 268-8175

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lab of Path, PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Searcy, AR
  • NPI 1831167196

  2062510076

  Same PAC ID

Practitioners 2

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

• James Henry Golleher Sr., M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Searcy, AR
  • NPI 1356319438
  Medicare reassignment NPD Authorized official
• Ruth Ann Reardon, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Searcy, AR
  • NPI 1497739668
  Medicare reassignment NPD

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1639397953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 W BEEBE CAPPS EXPY",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721435012",
            "telephone_number": "501-268-8175",
            "fax_number": "501-268-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 W BEEBE CAPPS EXPY",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721435012",
            "telephone_number": "501-268-8175",
            "fax_number": "501-268-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAB OF PATH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "GOLLEHER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "501-268-8175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AR",
            "license": "MC0253",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AR",
            "license": "MC0253",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "04D0891911",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREASTCARE OTHER",
            "identifier": "770093602",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREASTCARE",
            "identifier": "770046609",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP NUMBER",
            "identifier": "2022102",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106515709",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR LICENSE",
            "identifier": "MC0253",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• C W Koch Jr., M.D.
• Ryan Koch, DO
• Aaron T Koonce
• Robbi Marie Kulik, APRN
• Nivritti Kumaran, D.O.
• Lab of Path, PA
• Rena Michele Labeaud-Howard, PHARMD
• Christine Labonne
• Davon Lackie
• Laura Ladd

• Anatomic Pathology & Clinical Pathology Physician in Searcy, AR
• Providers in Searcy, AR by specialty
• Anatomic Pathology & Clinical Pathology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.