BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC. NPI 1003802075

Clinical Medical Laboratory in Prescott, AZ

Organization Clinical Medical Laboratory

About BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC.

Bradshaw Mountain Diagnostic Laboratory Inc. is a provider established in Prescott, Arizona specializing in clinical medical laboratory. The NPI number of Bradshaw Mountain Diagnostic Laboratory Inc. is 1003802075 and was assigned on September 2005. The practitioner's primary taxonomy code is 291U00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago.
The authorized official of this NPI record is Mr. Tom Fellows (President)

NPI

1003802075

Provider NameBRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC.
Provider Location Address990 WILLOW CREEK RD PRESCOTT, AZ 86301
Provider Mailing Address990 WILLOW CREEK RD PRESCOTT, AZ 86301
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?N/A
Enumeration Date09-23-2005
Last Update Date07-09-2007

Primary Taxonomy

Taxonomy Code291U00000X
ClassificationClinical Medical Laboratory
TypeLaboratories
License StateAZ
Taxonomy Description(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.

Business Address

BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC.
990 WILLOW CREEK RD
PRESCOTT, AZ
ZIP 86301
Phone: (928) 778-7823
Fax: (928) 778-9419

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Mailing Address

BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC.
990 WILLOW CREEK RD
PRESCOTT, AZ
ZIP 86301
Phone: (928) 778-7823
Fax: (928) 778-9419

Authorized Official

Authorized Official NameMR. TOM FELLOWS
Authorized Official TitlePRESIDENT
Authorized Official Phone(928) 778-7823

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
3L0008120MEDICARE ID-TYPE UNSPECIFIED (04)AZ
050576MEDICAID (05)AZ

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1407006646LABORATORY CORPORATION OF AMERICA
Organization
Clinical Medical Laboratory990 WILLOW CREEK RD
PRESCOTT, AZ 86301
(928) 778-7823

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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