Provider Demographics
NPI:1376590083
Name:SOUTH ARKANSAS PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:SOUTH ARKANSAS PATHOLOGY, PLLC
Other - Org Name:DRS. TISDALE & CLARK PATHOLOGISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-541-7524
Mailing Address - Street 1:1600 W 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6301
Mailing Address - Country:US
Mailing Address - Phone:870-541-7524
Mailing Address - Fax:870-541-7543
Practice Address - Street 1:1600 W 40TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6301
Practice Address - Country:US
Practice Address - Phone:870-541-7524
Practice Address - Fax:870-541-7543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINE BLUFF PATHOLOGISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-28
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770093502OtherBREASTCARE
AR57283OtherBCBS
AR110247002Medicaid
AR57283OtherBCBS