Provider Demographics
NPI:1215258645
Name:ARK-LA-TEX, LLC
Entity type:Organization
Organization Name:ARK-LA-TEX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-347-6203
Mailing Address - Street 1:3029 RISINGER DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-2716
Mailing Address - Country:US
Mailing Address - Phone:318-347-6203
Mailing Address - Fax:888-461-9729
Practice Address - Street 1:3029 RISINGER DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-2716
Practice Address - Country:US
Practice Address - Phone:318-347-6203
Practice Address - Fax:888-461-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory