Provider Demographics
NPI:1861032633
Name:NATURAL STATE GENOMICS LLC
Entity type:Organization
Organization Name:NATURAL STATE GENOMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HONEYCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-350-6597
Mailing Address - Street 1:PO BOX 26110
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-6110
Mailing Address - Country:US
Mailing Address - Phone:501-350-6597
Mailing Address - Fax:
Practice Address - Street 1:10915 N RODNEY PARHAM RD STE C
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4202
Practice Address - Country:US
Practice Address - Phone:501-539-1094
Practice Address - Fax:800-948-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory