Provista Health, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

03D1063366 Issued in AZ

Legal business name

PROVISTA HEALTH, LLC

Practice address

17301 N Perimeter Dr
Suite 100
Scottsdale, AZ 85255-5468

Phone

(602) 224-5500

NPI assigned

Dec 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tarun Jolly

Title

Owner

Phone

(504) 236-4030

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568332800000",
    "number": "1053595751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17301 N PERIMETER DR",
            "address_2": "SUITE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555468",
            "telephone_number": "602-224-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17301 N PERIMETER DR",
            "address_2": "SUITE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555468",
            "telephone_number": "602-224-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISTA HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2019-09-13",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "TARUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-236-4030"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D1063366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.