Arizona Independent Diagnostic Testing Facility PLLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

ARIZONA INDEPENDENT DIAGNOSTIC TESTING FACILITY PLLC

Practice address

8618 N 35TH Ave Ste 3
Phoenix, AZ 85051-3800

Phone

(602) 821-4517

NPI assigned

Dec 14, 2020

Organization subpart

No

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

Authorized official

Name

Jeff Brouwer

Title

Managing Member

Phone

(602) 821-4517

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1205422367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8660 S PEORIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741322827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8618 N 35TH AVE STE 3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850513800",
            "telephone_number": "602-821-4517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA INDEPENDENT DIAGNOSTIC TESTING FACILITY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-14",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "BROUWER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "602-821-4517"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physiological Laboratory in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physiological Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.