MEDICARE: CLINICAL STUDIES OF ARIZONA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	207SC0300X	Clinical Cytogenetics Physician

General Provider Information

NPI Number	:	1134891195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL STUDIES OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	2701 E THOMAS RD STE E
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8218
Country	:	US
Telephone Number	:	602-206-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 E THOMAS RD STE E
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8218
Country	:	US
Telephone Number	:	602-206-6649
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LILIANA SCOTT
Credential	:
Telephone Number	:	602-206-6649

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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