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General NPI Number Information
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NPI Number | 1093229908
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Entity Type | Organization
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Legal Business Name | COMPLETE REFERENCE LAB
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 4032 N MILLER RD STE A106
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4572
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Country | US
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Telephone | 817-793-5392
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Fax |
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Provider Business Mailing Address
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Address Line | 4032 N MILLER RD STE A106
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4572
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Country | US
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Telephone | 817-793-5392
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | JACK KENT
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Credential |
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Telephone | 817-793-5392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | PENDING
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License Number State |
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