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General NPI Number Information
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NPI Number | 1841290806
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Entity Type | Organization
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Legal Business Name | ALLIANCE MEDICAL LABORATORY, LLC
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1764 E ROUTE 66
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-5139
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Country | US
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Telephone | 928-773-2575
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Fax | 928-214-2680
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Provider Business Mailing Address
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Address Line | 1764 E ROUTE 66
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-5139
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Country | US
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Telephone | 928-773-2575
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Fax | 928-214-2680
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES A. PUFFENBERGER
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Credential |
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Telephone | 928-779-3366
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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 |
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License Number State | AZ
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