=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578578951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUMA HEALTH CARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 03/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 W 24TH ST
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-6370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-317-0920
-----------------------------------------------------
Fax | 928-317-0940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 W 24TH ST
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-6370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-317-0920
-----------------------------------------------------
Fax | 928-317-0940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LAB DIRECTOR
-----------------------------------------------------
Name | MR. JOHN T MERCADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-317-0920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------