Provider Demographics
NPI:1972069177
Name:COASTAL LABORATORY OF ARKANSAS
Entity Type:Organization
Organization Name:COASTAL LABORATORY OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-674-7453
Mailing Address - Street 1:2105 BEUMER ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-6423
Mailing Address - Country:US
Mailing Address - Phone:870-674-7453
Mailing Address - Fax:
Practice Address - Street 1:1012B E 22ND ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-6825
Practice Address - Country:US
Practice Address - Phone:870-674-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory