Provider Demographics
NPI:1053686964
Name:ADVANCED PATHOLOGY SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:ADVANCED PATHOLOGY SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-225-1400
Mailing Address - Street 1:5328 NORTHSHORE CV
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5332
Mailing Address - Country:US
Mailing Address - Phone:501-225-1400
Mailing Address - Fax:501-225-1401
Practice Address - Street 1:5328 NORTHSHORE CV
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5332
Practice Address - Country:US
Practice Address - Phone:501-225-1400
Practice Address - Fax:501-225-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0101X
AR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4554062Medicaid
KY7100437940Medicaid
TNQ028327Medicaid
NC1053686964Medicaid
TX3564890Medicaid
IA1053686964Medicaid
OH200633580AMedicaid
NJ33124566Medicaid
AL184345Medicaid
AR198170709Medicaid
AZ905992Medicaid
IL04554062Medicaid
NE1002650900Medicaid
IN201390500AMedicaid
MO700037530Medicaid
AL184345Medicaid