Provider Demographics
NPI:1790024131
Name:PHYSICIANS LABORATORIES OF AMERICA
Entity Type:Organization
Organization Name:PHYSICIANS LABORATORIES OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-712-1396
Mailing Address - Street 1:10 CORPORATE HILL DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4562
Mailing Address - Country:US
Mailing Address - Phone:877-202-5227
Mailing Address - Fax:501-408-3439
Practice Address - Street 1:10 CORPORATE HILL DR STE 180
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4562
Practice Address - Country:US
Practice Address - Phone:877-202-5227
Practice Address - Fax:501-408-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR291U00000XOtherTAXONOMY