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NPI Code Detail

MEDICARE: COLMED LABORATORIES & RADIOLOGY, LLC

MEDICARE: COLMED LABORATORIES & RADIOLOGY, 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1336558600
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLMED LABORATORIES & RADIOLOGY, LLC
Provider Business Mailing Address
First Line : 1724 W 4TH ST
Second Line :
City : TEMPE
State : AZ
Zip : 85281-7620
Country : US
Telephone Number : 602-317-6103
Fax Number : 480-718-8396
Provider Business Practice Location Address
First Line : 6392 MCLEOD DR STE 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-4417
Country : US
Telephone Number : 602-317-6103
Fax Number : 480-718-8396
Authorized Official
Title or Position : CEO
Name : SAMUEL AKERS
Credential :
Telephone Number : 602-317-6103
Provider Enumeration Date : 08/12/2014
Last Update Date : 08/12/2014

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