Arizona Independent Diagnostic Testing Facility PLLC

Physiological Laboratory in Phoenix, AZ. Organization (NPI-2).

NPI number1205422367

StatusActive

Last updated in NPPESDec 15, 2020

Details

NPI: 1205422367
Entity type: Organization (NPI-2)
Legal business name: Arizona Independent Diagnostic Testing Facility PLLC
Organization subpart: No
Enumeration date: Dec 14, 2020
Certification date: Dec 15, 2020
Last updated: Dec 15, 2020

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
293D00000X	Physiological Laboratory	–	–	Yes

Practice location

8618 N 35th Ave Ste 3
Phoenix, AZ 85051-3800

Phone 602-821-4517

Mailing address

8660 S Peoria Ave
Tulsa, OK 74132-2827

Authorized official

Jeff Brouwer
Managing Member
6028214517

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Physiological Laboratory providers in Phoenix, AZ

All 12 Physiological Laboratory providers in Phoenix · All 44,202 providers in Phoenix

Checking a whole list?

Paste a list of NPIs and get status, record, Medicare enrollment and OIG exclusion for each one. 100 free a day, then from $5 for 5,000. Useful for credentialing, billing and pharmacy claim checks.

Start a bulk check