Provider Demographics
NPI:1033168489
Name:ASSOCIATED PATHOLOGISTS LABORATORY PA
Entity Type:Organization
Organization Name:ASSOCIATED PATHOLOGISTS LABORATORY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANZALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-862-8046
Mailing Address - Street 1:208 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5756
Mailing Address - Country:US
Mailing Address - Phone:870-862-1351
Mailing Address - Fax:870-862-2815
Practice Address - Street 1:208 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5756
Practice Address - Country:US
Practice Address - Phone:870-862-1351
Practice Address - Fax:870-862-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZC0500X, 207ZP0102X
AR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140128002Medicaid
AR106086709Medicaid
AR140128002Medicaid
AR690083332Medicare PIN
AR56721Medicare PIN