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General NPI Number Information
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NPI Number | 1437695731
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Entity Type | Organization
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Legal Business Name | MEDICAL LABORATORY SPECIALTY, INC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 3636 ST
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City | KINGMAN
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State | AZ
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Zip | 86409
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Country | US
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Telephone | 928-757-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 529 W COLGATE DR
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City | TEMPE
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State | AZ
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Zip | 85283-1753
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Country | US
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Telephone | 480-703-4227
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAHAN FERDOUS
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Credential |
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Telephone | 480-703-4227
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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 | 03D2120368
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License Number State |
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