Provider Demographics
NPI:1558687525
Name:GRACE PATHOLOGY INC
Entity Type:Organization
Organization Name:GRACE PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:IRONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-379-8971
Mailing Address - Street 1:11711 HERMITAGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3718
Mailing Address - Country:US
Mailing Address - Phone:501-379-8971
Mailing Address - Fax:501-379-8976
Practice Address - Street 1:11711 HERMITAGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3718
Practice Address - Country:US
Practice Address - Phone:501-379-8971
Practice Address - Fax:501-379-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory