NPIMap

Organization Active NPI

Bradshaw Mountain Diagnostic Laboratory Inc

  • Clinical Medical Laboratory
  • Prescott Valley, AZ
National Provider Identifier
1790932820
Registry record updated Aug 20, 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
7732 East Florentine Rd
Prescott Valley, AZ 86314
Phone
(928) 772-5889
Fax
(928) 775-5678
NPI assigned
Aug 20, 2008
Organization subpart
Yes
Parent organization
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2008

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

7732 East Florentine Rd
Prescott Valley, AZ 86314

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Bradshaw MTN Diag Lab3 organizations share this tax ID, including this one
Part of
Bradshaw MTN Diag Lab

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": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219190400000",
    "number": "1790932820",
    "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": "7732 EAST FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86314",
            "telephone_number": "928-772-5889",
            "fax_number": "928-775-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-08-20",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.