=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588655336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARO INC DBA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 N 3RD ST #125
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85004-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-234-2994
-----------------------------------------------------
Fax | 602-234-3162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 N 3RD ST #125
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85004-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-234-2994
-----------------------------------------------------
Fax | 602-234-3162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. DOUG MAXWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-234-2994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | OTC 3587
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------