Bradshaw Mountain Diagnostic Laboratory Inc.

LBN: Bradshaw Mountain Diagnostic Laboratory Inc.
Bradshaw Mountain Diagnostic Laboratory Inc. is an health care organization with primary practice located at 990 Willow Creek Rd , Prescott AZ 86301-1640. The organization recently has only one registered license in Laboratories / Clinical Medical Laboratory, which is considered as the primary health care specialty. Bradshaw Mountain Diagnostic Laboratory Inc. can be contacted via phone (928) 778-7823, or through Fellows, Tom via phone (928) 778-7823.

Contact Information

Primary practice address
990 Willow Creek Rd Prescott AZ 86301-1640
Phone: (928) 778-7823
Fax: (928) 778-9419
Website:
Map and Directions
Authorized official contact:
Name: Fellows, Tom
Phone: (928) 778-7823

Health care specialties

SpecialtyCodeLicense #State
Laboratories / Clinical Medical Laboratory 291U00000X Arizona

Profile Details

NPI number 1003802075
LBN Legal business name Bradshaw Mountain Diagnostic Laboratory Inc.
DBA Doing business as
Authorized official Fellows, Tom
Entity Organization
Organization subpart 1 No
Enumeration date Sep 23rd, 2005
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003802075 NPPES
Arizona MEDICAID 050576

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