Basic Information
| Provider Information | |||||||||
| NPI: | 1619218393 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROPATH LABORATORIES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEPHROLAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10810 EXECUTIVE CENTER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016042695 | ||||||||
| FaxNumber: | 5016042699 | ||||||||
| Practice Location | |||||||||
| Address1: | 10810 EXECUTIVE CENTER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016042695 | ||||||||
| FaxNumber: | 5016042699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2013 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5016042695 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.