MEDICARE: AZTEC PATHOLOGY 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
2	291U00000X	Clinical Medical Laboratory

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DY0475	OTHER	AZ	MEDICARE RAILROAD PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407164486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZTEC PATHOLOGY LLC

Provider Business Mailing Address
First Line	:	576 W HORSESHOE PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-5119
Country	:	US
Telephone Number	:	623-806-1500
Fax Number	:	623-433-0174

Provider Business Practice Location Address
First Line	:	2538 E UNIVERSITY DR STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6925
Country	:	US
Telephone Number	:	623-806-1500
Fax Number	:	623-433-0174

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHVETA MEHRA
Credential	:	MD
Telephone Number	:	623-806-1500

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	03/04/2020

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Directions to “AZTEC PATHOLOGY LLC ” Practice Location

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