Healthcare Provider Details

I. General information

NPI: 1942961024
Provider Name (Legal Business Name): KMSA TESTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E INDIAN SCHOOL RD APT 2119
PHOENIX AZ
85012-1886
US

IV. Provider business mailing address

411 E INDIAN SCHOOL RD APT 2119
PHOENIX AZ
85012-1886
US

V. Phone/Fax

Practice location:
  • Phone: 480-241-2197
  • Fax:
Mailing address:
  • Phone: 480-241-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARINA A CORNETT
Title or Position: PARTNER
Credential:
Phone: 480-241-2197