Active NPI
Medical Associates PA Lab
- Clinical Medical Laboratory
- Pine Bluff, AR
National Provider Identifier
1649320227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- MEDICAL ASSOCIATES PA LAB
- Practice address
- 4201 S Mulberry St
Pine Bluff, AR 71603-7016 - Phone
- (870) 535-2200
- Fax
- (870) 535-2208
- NPI assigned
- Jan 12, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. John D Dedman, M.D.
- Title
- Owner
- Phone
- (870) 535-2200
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | AR | Primary |
Addresses
Primary practice location
4201 S Mulberry St
Pine Bluff, AR 71603-7016
Mailing address
4201 S Mulberry St
Pine Bluff, AR 71603-7016
Phone (870) 535-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18066 | Other | AR | ARK BLUE CROSS BLUE SHIEL |
National Provider Directory
National Provider Directory- Tax ID family
- Medical Associates PA Lab
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Internal Medicine Physician
- Pine Bluff, AR
- NPI 1386670057
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Pine Bluff, AR
- NPI 1770510331
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1649320227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 S MULBERRY ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716037016",
"telephone_number": "870-535-2200",
"fax_number": "870-535-2208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 S MULBERRY ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716037016",
"telephone_number": "870-535-2200",
"fax_number": "870-535-2208"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICAL ASSOCIATES PA LAB",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-12",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "DEDMAN",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "870-535-2200",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "AR",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARK BLUE CROSS BLUE SHIEL",
"identifier": "18066",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.