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General NPI Number Information
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NPI Number | 1548539661
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Entity Type | Organization
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Legal Business Name | CARIS MOLECULAR PATHOLOGY
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 4610 SOUTH 44TH PLACE
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City | PHOENIX
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State | AZ
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Zip | 85040
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Country | US
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Telephone | 602-464-7664
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Fax | 214-716-4125
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Provider Business Mailing Address
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Address Line | 750 WEST JOHN CARPENTER FREEWAY. C/O KELLY BERMAN SUITE 800
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City | IRVING
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State | TX
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Zip | 75039-2443
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Country | US
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Telephone | 214-294-5558
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Fax | 214-294-5640
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Authorized Official
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Title or Position | CFO AND CAO AND TREASURER
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Name | LUKE POWER
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Credential |
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Telephone | 214-294-5568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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