Provider Demographics
NPI:1841465481
Name:SPA CITY PATHOLOGY, P.A.
Entity type:Organization
Organization Name:SPA CITY PATHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-624-4547
Mailing Address - Street 1:PO BOX 22304
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-2304
Mailing Address - Country:US
Mailing Address - Phone:501-624-4547
Mailing Address - Fax:501-624-4547
Practice Address - Street 1:801 CENTRAL AVE
Practice Address - Street 2:STE 32
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5315
Practice Address - Country:US
Practice Address - Phone:501-624-4547
Practice Address - Fax:501-624-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty