NPIMap

Organization Active NPI

Bradshaw Mountain Diagnostic Laboratory Inc

  • Clinical Medical Laboratory
  • Cottonwood, AZ
National Provider Identifier
1144476896
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC
Practice address
203 S Candy LN
Suite 115-B2
Cottonwood, AZ 86326-4120
Phone
(928) 634-0495
Fax
(928) 634-0565
NPI assigned
Aug 13, 2008
Last updated
Aug 13, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Authorized official

Name
Tom Fellows
Title
President
Phone
(928) 778-7823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

203 S Candy LN
Suite 115-B2
Cottonwood, AZ 86326-4120

Mailing address

990 Willow Creek Rd
Prescott, AZ 86301-1640
Phone (928) 778-7823

National Provider Directory

National Provider Directory
Tax ID family
Bradshaw Mountain Diag3 organizations share this tax ID, including this one
Part of
Bradshaw Mountain Diag

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1144476896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011640",
            "telephone_number": "928-778-7823",
            "fax_number": "928-778-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S CANDY LN",
            "address_2": "SUITE 115-B2",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264120",
            "telephone_number": "928-634-0495",
            "fax_number": "928-634-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "FELLOWS",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-778-7823"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.