Provider Demographics
NPI:1760994453
Name:PHOENIX LABS LLC
Entity Type:Organization
Organization Name:PHOENIX LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-7688
Mailing Address - Street 1:11908 KANIS RD STE G8
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3773
Mailing Address - Country:US
Mailing Address - Phone:501-228-5556
Mailing Address - Fax:501-228-5558
Practice Address - Street 1:11908 KANIS RD STE G8
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3773
Practice Address - Country:US
Practice Address - Phone:501-228-5556
Practice Address - Fax:501-228-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARBL155832247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARBL155832OtherBUSINESS LICENSE
AR66366858-SLSOtherSTATE SALES TAX ID