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General NPI Number Information
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NPI Number | 1528518826
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTH, LLC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 100 STREET A STE C
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City | PICAYUNE
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State | MS
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Zip | 39466-5459
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Country | US
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Telephone | 601-373-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 100 STREET A STE C
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City | PICAYUNE
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State | MS
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Zip | 39466-5459
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Country | US
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Telephone | 601-373-3330
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PHILIP A MARTINEZ
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Credential |
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Telephone | 805-709-2138
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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 | 25D2113923
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License Number State | MS
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