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General NPI Number Information
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NPI Number | 1396191672
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Entity Type | Organization
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Legal Business Name | MEDICAL LABS OF ARIZONA LLC
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 15455 N GREENWAY HAYDEN LOOP STE C16
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1886
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Country | US
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Telephone | 480-939-4656
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Fax | 480-524-1070
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Provider Business Mailing Address
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Address Line | 15455 N GREENWAY HAYDEN LOOP STE C16
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1886
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Country | US
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Telephone | 480-939-4656
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Fax | 480-524-1070
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY TERRILL
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Credential |
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Telephone | 480-939-4656
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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 | 03D2098042
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License Number State | AZ
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