Provider Demographics
NPI:1992413710
Name:AR RURAL DIAGNOSTICS PCR, LLC
Entity type:Organization
Organization Name:AR RURAL DIAGNOSTICS PCR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-382-1291
Mailing Address - Street 1:6339 E SPEEDWAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1147
Mailing Address - Country:US
Mailing Address - Phone:866-950-8013
Mailing Address - Fax:
Practice Address - Street 1:19 MEDICAL PLZ STE 20
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2962
Practice Address - Country:US
Practice Address - Phone:870-218-0683
Practice Address - Fax:479-763-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Yes291U00000XLaboratoriesClinical Medical Laboratory