Provider Demographics
NPI:1720331796
Name:NORTHWEST ARKANSAS PATHOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:NORTHWEST ARKANSAS PATHOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-442-0144
Mailing Address - Street 1:390 E LONGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4618
Mailing Address - Country:US
Mailing Address - Phone:479-442-0144
Mailing Address - Fax:479-442-4557
Practice Address - Street 1:390 E LONGVIEW ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4618
Practice Address - Country:US
Practice Address - Phone:479-442-0144
Practice Address - Fax:479-442-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116874002Medicaid
AR18070Medicare UPIN