PHOENIX LABS LLC (NPI# 1760994453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760994453 |
| Entity Type | Organization |
| Organization Name | PHOENIX LABS LLC |
| Practice Address |
11908 Kanis Rd Ste G8 Little Rock AR 72211-3773 |
| Practice Telephone | 5012285556 |
| Practice Fax Number | 5012285558 |
| Mailing Telephone | 5012285556 |
| Mailing Fax Number | 5012285558 |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-02 |
| Authorized Official Name | MRS. ERIN C THOMAS (HR) |
| Authorized Official Telephone | 5012277688 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 247ZC0005X |
Pathology Specialization: Clinical Laboratory Director, Non-physician |
BL155832 | AR | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | BUSINESS LICENSE | BL155832 | 01 |
| AR | STATE SALES TAX ID | 66366858-SLS | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Phoenix Labs LLC | 8337 South Valley Highway Apt 205, Centennial, CO 80112 |
| Street Address |
11908 KANIS RD STE G8 |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72211-3773 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004618 | Samantha Lenore Hilborn | Behavior Technician | 1525 Merrill Drive Suite 100, Little Rock, AR 72211 | 2020-05-14 |
| 1003437740 | Centers for Youth and Families, Inc. | Community/Behavioral Health | 1521 Merrill Drive, Suite D220 and E200, Little Rock, AR 72211 | 2020-05-05 |
| 1962040568 | Erica N Taylor | Nurse Practitioner | 11800 Financial Center Parkway, Ste 290, Little Rock, AR 72211 | 2019-12-13 |
| 1568932119 | Katie Jones | Nurse Practitioner | 1children's Way, Little Rock, AR 72211 | 2018-11-27 |
| 1356828651 | Kayleigh King | Dietitian, Registered | 4 Shackleford Plz Ste 209, Little Rock, AR 72211 | 2018-07-19 |
| 1699283838 | Kara Elizabeth Simmons | Physician Assistant | 11215 Hermitage Rd Ste 103, Little Rock, AR 72211 | 2018-01-22 |
| 1194241463 | Wendy Newsam Pllc | Counselor | 1 Innwood Circle, Suite 107, Little Rock, AR 72211 | 2017-08-18 |
| 1861915159 | Sarah Renee Beall | Counselor | 10800 Financial Centre #290, Little Rock, AR 72211 | 2017-07-19 |
| 1457873127 | Restore Hope Counseling Center, Pllc | Counselor | One Innwood Circle, Suite 201, Little Rock, AR 72211 | 2017-07-13 |
| 1447707500 | University of Arkansas for Medical Sciences | Durable Medical Equipment & Medical Supplies | 601 Autumn Road, Little Rock, AR 72211 | 2016-09-07 |
| Find all providers in zip 72211 | ||||
| Taxonomy Code | 247ZC0005X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Pathology |
| Specialization | Clinical Laboratory Director, Non-physician |
| An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405. |
| Notes: Source: National Uniform Claim Committee [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679813372 | Akhtar Afshan Ali | Pathology | 4301 W Markham St, Slot 831, Little Rock, AR 72205-7101 | 2013-02-18 |
| City | LITTLE ROCK |
| Zip Code | 72211 |
Please comment or provide details below to improve the information on PHOENIX LABS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.