Provider Demographics
NPI:1841236734
Name:DOCTORS' ANATOMIC PATHOLOGY SERVICES, PA
Entity Type:Organization
Organization Name:DOCTORS' ANATOMIC PATHOLOGY SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-930-3518
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1326
Mailing Address - Country:US
Mailing Address - Phone:870-930-3518
Mailing Address - Fax:870-930-3569
Practice Address - Street 1:411 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-930-3518
Practice Address - Fax:870-930-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN5534OtherRAILROAD MEDICARE
CQ3031OtherRAILROAD MEDICARE
AR5B433OtherBLUE CROSS BLUE SHIELD
CQ3031OtherRAILROAD MEDICARE