Provider Demographics
NPI:1780946517
Name:DERMLOGIC, P.L.L.C, PA
Entity type:Organization
Organization Name:DERMLOGIC, P.L.L.C, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-551-6408
Mailing Address - Street 1:9780 MAUMELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6737
Mailing Address - Country:US
Mailing Address - Phone:501-753-9000
Mailing Address - Fax:501-753-9004
Practice Address - Street 1:9780 MAUMELLE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6737
Practice Address - Country:US
Practice Address - Phone:501-753-9000
Practice Address - Fax:501-753-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3291291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory