Provider Demographics
NPI:1255388997
Name:MEDICAL LABORATORIES OF ARKANSAS, INC.
Entity type:Organization
Organization Name:MEDICAL LABORATORIES OF ARKANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-812-7508
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-202-6522
Mailing Address - Fax:501-202-1429
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-202-6522
Practice Address - Fax:501-202-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCLIA-04D1053341291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162836709Medicaid
AR18126Medicare PIN
AR162836709Medicaid