Healthcare Provider Details

I. General information

NPI: 1013973866
Provider Name (Legal Business Name): CARIS MPI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 06/10/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 SOUTH 44TH PLACE
PHOENIX AZ
85040-4010
US

IV. Provider business mailing address

750 W JOHN CARPENTER FWY STE 800 C/O KELLY BERMAN
IRVING TX
75039-2520
US

V. Phone/Fax

Practice location:
  • Phone: 888-979-8669
  • Fax: 480-522-3506
Mailing address:
  • Phone: 888-979-8669
  • Fax: 480-522-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number03D1019490
License Number StateAZ

VIII. Authorized Official

Name: LUKE POWER
Title or Position: CFO AND CAO AND TREASURER
Credential:
Phone: 214-294-5568