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General NPI Number Information
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NPI Number | 1659751246
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Entity Type | Organization
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Legal Business Name | FORTIS LAB MANAGEMENT, LLC.
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 15210 N SCOTTSDALE RD SUITE 210
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-8124
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Country | US
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Telephone | 520-477-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 4969 VAN DYKE RD SUITE 210
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City | LUTZ
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State | FL
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Zip | 33558-4813
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Country | US
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Telephone | 520-477-8907
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL PIPER
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Credential |
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Telephone | 813-390-8181
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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 | 800027166
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License Number State | FL
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