Provider Demographics
NPI:1821156035
Name:NEPHROPATHOLOGY ASSOCIATES, PLC
Entity Type:Organization
Organization Name:NEPHROPATHOLOGY ASSOCIATES, PLC
Other - Org Name:ARKANA LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-604-2695
Mailing Address - Street 1:10810 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4386
Mailing Address - Country:US
Mailing Address - Phone:501-604-2695
Mailing Address - Fax:501-604-2699
Practice Address - Street 1:10810 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4386
Practice Address - Country:US
Practice Address - Phone:501-604-2695
Practice Address - Fax:501-604-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2034207ZP0101X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR272534Medicaid
SCL00307Medicaid
FL912012200Medicaid
CO95323287Medicaid
AZ368483Medicaid
ID807547100Medicaid
WV3810017266BMedicaid
AL529911940Medicaid
FLN210291OtherWELLCARE, FL HEALTHEASE ONLY
TN1504795Medicaid
TX210587601Medicaid
OK200279440 AMedicaid
TX210587601Medicaid