NPIMap

Organization Active NPI

Main Street Diagnostic, LLC

  • Substance Abuse Rehabilitation Facility
  • Cottonwood, AZ
National Provider Identifier
1972639748
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
PENDING Issued in AZ
Legal business name
MAIN STREET DIAGNOSTIC, LLC
Practice address
636 N Main St
Cottonwood, AZ 86326-3725
Phone
(928) 639-4440
Fax
(928) 639-3924
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Maria Carrillo
Title
Finance Coordinator
Phone
(928) 639-4440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X PENDING AZ Primary

Addresses

Primary practice location

636 N Main St
Cottonwood, AZ 86326-3725

Mailing address

636 N Main St
Cottonwood, AZ 86326-3725
Phone (928) 639-4440

Other names 1

  • MINGUS CENTER - RIO DE ESPERANZA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Main Street Diagnostic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972639748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 N MAIN ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863263725",
            "telephone_number": "928-639-4440",
            "fax_number": "928-639-3924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 N MAIN ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863263725",
            "telephone_number": "928-639-4440",
            "fax_number": "928-639-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DIAGNOSTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "FINANCE COORDINATOR",
        "authorized_official_telephone_number": "928-639-4440"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MINGUS CENTER - RIO DE ESPERANZA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 22, 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.