Bradshaw Mountain Diagnostic Laboratory INC.
Clinical Medical Laboratory in Prescott, AZ. Organization (NPI-2).
NPI number1003802075
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1003802075
- Entity type
- Organization (NPI-2)
- Legal business name
- Bradshaw Mountain Diagnostic Laboratory INC.
- Organization subpart
- No
- Enumeration date
- Sep 23, 2005
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291U00000X | Clinical Medical Laboratory | 03D0533969 | AZ | Yes |
Practice location
990 Willow Creek RdPrescott, AZ 86301-1640
Phone 928-778-7823 · Fax 928-778-9419
Mailing address
990 Willow Creek RdPrescott, AZ 86301-1640
Phone 928-778-7823 · Fax 928-778-9419
Authorized official
Tom Fellows
President
9287787823
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