MEDICARE: KEMPTON & NELSON DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory	OTC5108	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639162779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEMPTON & NELSON DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	4852 E BASELINE RD
Second Line	:	SUITE 109
City	:	MESA
State	:	AZ
Zip	:	85206-4627
Country	:	US
Telephone Number	:	480-610-6400
Fax Number	:	480-964-4455

Provider Business Practice Location Address
First Line	:	4852 E BASELINE RD
Second Line	:	SUITE 109
City	:	MESA
State	:	AZ
Zip	:	85206-4627
Country	:	US
Telephone Number	:	480-610-6400
Fax Number	:	480-964-4455

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. MICHAEL ERIC CARRERA
Credential	:
Telephone Number	:	480-964-4242

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/24/2016

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Directions to “KEMPTON & NELSON DIAGNOSTICS LLC ” Practice Location

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