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General NPI Number Information
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NPI Number | 1396202602
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Entity Type | Organization
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Legal Business Name | BEECHTREE DIAGNOSTICS LLP
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 41818 N VENTURE DR STE 150
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City | ANTHEM
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State | AZ
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Zip | 85086-3190
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Country | US
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Telephone | 602-881-7810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35146
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City | SEATTLE
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State | WA
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Zip | 98124-5146
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Country | US
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Telephone | 801-893-2773
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Fax | 801-683-9907
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MATTHEW SEAMAN-HYATT CHAMBERS
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Credential | MHA
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Telephone | 801-893-2773
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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 |
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License Number State |
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