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General NPI Number Information
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NPI Number | 1386190718
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Entity Type | Organization
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Legal Business Name | MONOLITH DIAGNOSTICS, PC
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1740 SYCAMORE AVE STE. C
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City | KINGMAN
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State | AZ
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Zip | 86409-0942
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Country | US
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Telephone | 928-263-3706
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Fax | 928-263-3604
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Provider Business Mailing Address
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Address Line | PO BOX 6024
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City | KINGMAN
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State | AZ
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Zip | 86402-6024
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Country | US
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Telephone | 928-263-3706
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Fax | 928-263-3604
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN E SWAPP
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Credential |
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Telephone | 928-263-3706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 47589
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 47589
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License Number State | AZ
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