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General NPI Number Information
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NPI Number | 1528561362
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Entity Type | Organization
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Legal Business Name | BEACON BIOMEDICAL INC.
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 275 N GATEWAY DR STE 149
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City | PHOENIX
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State | AZ
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Zip | 85034-1700
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Country | US
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Telephone | 480-757-9037
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Fax |
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Provider Business Mailing Address
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Address Line | 275 N GATEWAY DR STE 149
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City | PHOENIX
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State | AZ
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Zip | 85034-1700
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Country | US
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Telephone | 480-757-9037
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. FREDERICK RANDALL GRIMES
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Credential | MBA
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Telephone | 480-757-9037
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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 | 03D2122615
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License Number State | AZ
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