Provider Demographics
NPI:1285858423
Name:MERCY PATHOLOGY PRACTICE PLC
Entity Type:Organization
Organization Name:MERCY PATHOLOGY PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SESHAGIRIRAO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMMARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:501-624-4547
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:801 CENTRAL AVE SUITE 32
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902
Mailing Address - Country:US
Mailing Address - Phone:501-624-4547
Mailing Address - Fax:501-624-5697
Practice Address - Street 1:801 CENTRAL AVE
Practice Address - Street 2:SUITE 32
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71902
Practice Address - Country:US
Practice Address - Phone:501-624-4547
Practice Address - Fax:501-624-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2634207ZP0102X
ARR4386207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C358OtherBCBS
AR5C358OtherBCBS