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General NPI Number Information
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NPI Number | 1427449420
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Entity Type | Organization
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Legal Business Name | ORION HEALTHCORP
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 297 KINGSBURY GRADE STE 100
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City | STATELINE
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State | NV
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Zip | 89449-9804
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Country | US
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Telephone | 480-389-8197
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Fax | 480-393-7521
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Provider Business Mailing Address
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Address Line | PO BOX 52505
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City | PHOENIX
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State | AZ
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Zip | 85072-2505
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Country | US
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Telephone | 480-389-1975
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JOHN MIADICH
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Credential |
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Telephone | 480-389-1975
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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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